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Pennock State Street Center
Family Nurse Practitioner in Hastings, Michigan
NPI 1932490885

Pennock State Street Center is a Family Nurse Practitioner based in Grand Rapids, MI and is specialized in Family. Pennock State Street Center practices in Hastings, MI. The NPI Number for Pennock State Street Center is 1932490885 and holds a License No. (Michigan).

The current practice location address for Pennock State Street Center is 1108 W State St, Hastings, MI and can be reached out via phone at 269-948-3360.

Location: 1108 W State St, Hastings, MI, 49546-2416
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1932490885
Provider Name
Pennock State Street Center
Credential
Provider Entity Type
Organization
Address
1108 W State St, Hastings, MI, 49546-2416
Phone Number
269-948-3360
Fax Number
Provider Enumeration Date
04/27/2011
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0Z80041 01 MI BCBS
institution
Provider Business Practice Location Address Details
Address
1108 W State St
City
Hastings
State
Michigan
Zip
49058-9711
Phone Number
269-948-3360
Fax Number
person
Provider Business Mailing Address Details
Address
1108 W State St
City
Hastings
State
Michigan
Zip
49058-9711
Phone Number
269-948-3360
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
()
Definition
Definition to come...
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