Provider Demographics
NPI:1205249414
Name:GRITTERS, DANIEL JAY (NP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAY
Last Name:GRITTERS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:JAY
Other - Last Name:GRITTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:4100 LAKE DR SE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8292
Practice Address - Country:US
Practice Address - Phone:616-267-8244
Practice Address - Fax:616-267-7272
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276335163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse