Provider Demographics
NPI:1871181883
Name:STARR, MYRNA R (NP-C)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:R
Last Name:STARR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 BRIDLE CREEK ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5170
Mailing Address - Country:US
Mailing Address - Phone:231-855-2282
Mailing Address - Fax:
Practice Address - Street 1:2774 BIRCHCREST DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-5477
Practice Address - Country:US
Practice Address - Phone:616-570-4776
Practice Address - Fax:888-977-1716
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704306891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily