Basic Information
| Provider Information | |||||||||
| NPI: | 1548800113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAUTA | ||||||||
| FirstName: | ARYN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3138 S RIVERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | TWIN LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494579784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317405987 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1560 E SHERMAN BLVD STE 240 | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316723883 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2020 | ||||||||
| LastUpdateDate: | 01/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601009772 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.