Healthcare Provider Details

I. General information

NPI: 1396488540
Provider Name (Legal Business Name): ANNA FLORES DCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 CASCADE RD SE STE 102
GRAND RAPIDS MI
49546-3665
US

IV. Provider business mailing address

4500 CASCADE RD SE STE 102
GRAND RAPIDS MI
49546-3665
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-8403
  • Fax: 616-741-2313
Mailing address:
  • Phone: 616-209-8403
  • Fax: 616-741-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: