Provider Demographics
NPI:1417619628
Name:MAHRLE, GUDRUN E (RN)
Entity Type:Individual
Prefix:
First Name:GUDRUN
Middle Name:E
Last Name:MAHRLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GUDRUN
Other - Middle Name:E
Other - Last Name:GRENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:690 AIRWAY DR # 231
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 HAZEN ST STE C
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-2008
Practice Address - Country:US
Practice Address - Phone:269-657-5574
Practice Address - Fax:269-657-3474
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704129799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse