Healthcare Provider Details

I. General information

NPI: 1386334167
Provider Name (Legal Business Name): GLADYS O KUIK NP CERTIFICATION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 SPARKS DR SE STE 103
GRAND RAPIDS MI
49546-6159
US

IV. Provider business mailing address

189 WAXWING CT
CEDAR SPRINGS MI
49319-8162
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704291158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: