Healthcare Provider Details

I. General information

NPI: 1114680030
Provider Name (Legal Business Name): JULIANNA KAY SCHLOZ PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANNA KAY HERGENREDER PNP

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MICHIGAN ST NE STE 1800
GRAND RAPIDS MI
49503-2568
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 616-391-3933
  • Fax:
Mailing address:
  • Phone: 616-486-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704377676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: