Provider Demographics
NPI:1477049518
Name:CONTRERAS, MARK (AGNP-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 LAFAYETTE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5092
Mailing Address - Country:US
Mailing Address - Phone:616-336-8800
Mailing Address - Fax:616-331-9831
Practice Address - Street 1:1211 LAFAYETTE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5092
Practice Address - Country:US
Practice Address - Phone:616-336-8800
Practice Address - Fax:616-331-9831
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704283879363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health