Provider Demographics
NPI:1952439481
Name:PNA LTD.
Entity Type:Organization
Organization Name:PNA LTD.
Other - Org Name:PROFESSIONAL NURSING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-755-7115
Mailing Address - Street 1:905 W SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4049
Mailing Address - Country:US
Mailing Address - Phone:231-755-7115
Mailing Address - Fax:231-759-7122
Practice Address - Street 1:905 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4049
Practice Address - Country:US
Practice Address - Phone:231-755-7115
Practice Address - Fax:231-759-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4364414251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4364414Medicaid