Healthcare Provider Details

I. General information

NPI: 1821653403
Provider Name (Legal Business Name): GAYNEL NAVE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 LAKE DR SE
GRAND RAPIDS MI
49506-1479
US

IV. Provider business mailing address

834 LAKE DR SE
GRAND RAPIDS MI
49506-1479
US

V. Phone/Fax

Practice location:
  • Phone: 616-855-0931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number19-1776
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: