Provider Demographics
NPI:1669097333
Name:BAAR, NATHAN (MHA, BSN, RN, CEN)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BAAR
Suffix:
Gender:M
Credentials:MHA, BSN, RN, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 CHESAPEAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-6407
Mailing Address - Country:US
Mailing Address - Phone:616-200-8584
Mailing Address - Fax:
Practice Address - Street 1:2230 CHESAPEAKE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6407
Practice Address - Country:US
Practice Address - Phone:616-200-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704274094163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse