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General NPI Number Information
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NPI Number | 1740842657
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Entity Type | Individual
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Provider Name | MICHELLE JAYME KLOSS DNP, APRN, AGNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 231 W PINE LAKE DR
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City | NEWAYGO
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State | MI
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Zip | 49337-9264
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Country | US
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Telephone | 231-652-4107
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Fax | 231-652-4620
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Provider Business Mailing Address
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Address Line | 10700 TRAILSIDE WOODS DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7213
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Country | US
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Telephone | 616-206-2784
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704309389
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License Number State | MI
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