Healthcare Provider Details

I. General information

NPI: 1841919057
Provider Name (Legal Business Name): CATTLEYA NERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E MOUNT HOPE AVE
LANSING MI
48910-1822
US

IV. Provider business mailing address

3955 PATIENT CARE DR STE A
LANSING MI
48911-4271
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-3704
  • Fax: 855-501-6733
Mailing address:
  • Phone: 517-374-7600
  • Fax: 855-495-5457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704297256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: