Provider Demographics
NPI:1275884454
Name:MCCOLLUM, KARYN ROCHELLE (NP)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:ROCHELLE
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-8635
Mailing Address - Fax:616-391-8621
Practice Address - Street 1:221 MICHIGAN ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2543
Practice Address - Country:US
Practice Address - Phone:616-391-8635
Practice Address - Fax:616-391-8621
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704249006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner