Healthcare Provider Details

I. General information

NPI: 1295696763
Provider Name (Legal Business Name): NICHOLAS JAMES GRALA MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11611 PINE LAKE RD
PLAINWELL MI
49080-9225
US

IV. Provider business mailing address

11611 PINE LAKE RD
PLAINWELL MI
49080-9225
US

V. Phone/Fax

Practice location:
  • Phone: 269-664-9564
  • Fax:
Mailing address:
  • Phone: 269-664-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704253681
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: