Provider Demographics
NPI:1326691791
Name:EASTWAY, KORY ALLEN (NP)
Entity Type:Individual
Prefix:MR
First Name:KORY
Middle Name:ALLEN
Last Name:EASTWAY
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:3290 N WELLNESS DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7261
Mailing Address - Country:US
Mailing Address - Phone:616-685-7450
Mailing Address - Fax:616-685-7455
Practice Address - Street 1:3290 N WELLNESS DR STE 220
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7261
Practice Address - Country:US
Practice Address - Phone:616-685-7450
Practice Address - Fax:616-685-7455
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704284756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily