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General NPI Number Information
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NPI Number | 1548800113
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Entity Type | Individual
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Provider Name | ARYN NAUTA PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/01/2021
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Provider Practice Location Address
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Address Line | 1560 E SHERMAN BLVD STE 240
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City | MUSKEGON
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State | MI
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Zip | 49444-1854
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Country | US
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Telephone | 231-672-3883
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Fax |
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Provider Business Mailing Address
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Address Line | 3138 S RIVERWOOD DR
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City | TWIN LAKE
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State | MI
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Zip | 49457-9784
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Country | US
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Telephone | 231-740-5987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601009772
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License Number State | MI
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