Provider Demographics
NPI:1740842657
Name:KLOSS, MICHELLE JAYME (DNP, APRN, AGNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JAYME
Last Name:KLOSS
Suffix:
Gender:F
Credentials:DNP, APRN, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 TRAILSIDE WOODS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7213
Mailing Address - Country:US
Mailing Address - Phone:616-206-2784
Mailing Address - Fax:
Practice Address - Street 1:231 W PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-9264
Practice Address - Country:US
Practice Address - Phone:231-652-4107
Practice Address - Fax:231-652-4620
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309389363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology