Healthcare Provider Details

I. General information

NPI: 1093666034
Provider Name (Legal Business Name): ZAWNG NAW SUMLUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 ROYAL VISTAL CT NW 301
GRAND RAPIDS MI
49534
US

IV. Provider business mailing address

2715 ROYAL VISTAL CT NW 301
GRAND RAPIDS MI
49534
US

V. Phone/Fax

Practice location:
  • Phone: 269-213-7768
  • Fax:
Mailing address:
  • Phone: 269-213-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: