Healthcare Provider Details

I. General information

NPI: 1740946110
Provider Name (Legal Business Name): ANDREW MARK SKOWRONEK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7751 BYRON CENTER AVE SW STE C
BYRON CENTER MI
49315-8001
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-7668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704304031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: