Healthcare Provider Details

I. General information

NPI: 1942140686
Provider Name (Legal Business Name): EVA ISABEL DE JESUS MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 N MAIN ST
CEDAR SPRINGS MI
49319-8041
US

IV. Provider business mailing address

261 N MAIN ST
CEDAR SPRINGS MI
49319-8041
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-2020
  • Fax: 877-779-0621
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: