Basic Information
Provider Information
NPI: 1164831475
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOHL
FirstName: MEGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GRAY
OtherFirstName: MEGAN
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: NP
OtherLastNameType: 1
Mailing Information
Address1: 100 MICHIGAN ST NE # MC845
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495032560
CountryCode: US
TelephoneNumber: 6164866790
FaxNumber:  
Practice Location
Address1: 2750 E BELTLINE AVE NE
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495258614
CountryCode: US
TelephoneNumber: 6162677015
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/12/2014
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704277876MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home