Provider Demographics
NPI:1497367205
Name:DRENTH, PAUL RAYMOND JR (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RAYMOND
Last Name:DRENTH
Suffix:JR
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6934
Mailing Address - Country:US
Mailing Address - Phone:989-953-5320
Mailing Address - Fax:
Practice Address - Street 1:2790 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6934
Practice Address - Country:US
Practice Address - Phone:989-956-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704330961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily