Provider Demographics
NPI:1629673280
Name:MALVAR, EMILY LAUREN (AGNP, DNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:MALVAR
Suffix:
Gender:F
Credentials:AGNP, DNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP
Mailing Address - Street 1:270 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3719
Mailing Address - Country:US
Mailing Address - Phone:616-396-5444
Mailing Address - Fax:855-863-9540
Practice Address - Street 1:270 HOOVER BLVD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3719
Practice Address - Country:US
Practice Address - Phone:616-396-5444
Practice Address - Fax:855-863-9540
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318621363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner