Healthcare Provider Details

I. General information

NPI: 1407744055
Provider Name (Legal Business Name): YURI PIZANO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 STOCKING AVE NW
GRAND RAPIDS MI
49504-5176
US

IV. Provider business mailing address

669 STOCKING AVE NW
GRAND RAPIDS MI
49504-5176
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-0761
  • Fax:
Mailing address:
  • Phone: 616-235-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704252340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: