Healthcare Provider Details

I. General information

NPI: 1376353086
Provider Name (Legal Business Name): SYREETA DRAKE MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYREETA NELSON MSN, RN

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 124
GRAND RAPIDS MI
49503-3262
US

IV. Provider business mailing address

233 FULTON ST E STE 124
GRAND RAPIDS MI
49503-3262
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3890
  • Fax:
Mailing address:
  • Phone: 616-805-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024009011
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: