MEDICARE: ADVANCED PRACTICE NURSE STAFFING ASSOCIATE, LLC

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
1	363LF0000X	Family Nurse Practitioner
2	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1336665769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PRACTICE NURSE STAFFING ASSOCIATE, LLC

Provider Business Mailing Address
First Line	:	4448 KOINONIA DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4448 KOINONIA DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9332
Country	:	US
Telephone Number	:	616-649-3776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GRETCHEN SCHUMACHER
Credential	:	PHD, NP
Telephone Number	:	616-649-3776

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	01/10/2018

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