Healthcare Provider Details

I. General information

NPI: 1942789805
Provider Name (Legal Business Name): JILLIAN R GRZEGORCZYK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN RENEE KILDUFF

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 HOLTON RD
MUSKEGON MI
49445-1578
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-935-3479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704274790
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: