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NPI Code Detail

MEDICARE: RENATA A NYTKO PA-C

MEDICARE: RENATA A NYTKO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601003494MI

General Provider Information

NPI Number : 1285615443
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENATA A NYTKO PA-C
Provider Business Mailing Address
First Line : PO BOX 1847
Second Line :
City : MUSKEGON
State : MI
Zip : 49443-1847
Country : US
Telephone Number : 231-727-4444
Fax Number : 231-728-4789
Provider Business Practice Location Address
First Line : 1500 E SHERMAN BLVD
Second Line :
City : MUSKEGON
State : MI
Zip : 49444-1849
Country : US
Telephone Number : 231-672-3883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 05/16/2014

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Directions to “ RENATA A NYTKO PA-C” Practice Location

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