Healthcare Provider Details

I. General information

NPI: 1073265310
Provider Name (Legal Business Name): TAYLOR ROSE HURT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR ROSE KROEZE NP

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W STATE ST STE 3
HASTINGS MI
49058-9711
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 269-945-0922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704358551
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: