Basic Information
Provider Information
NPI: 1538446976
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAIN
FirstName: AARON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 36115 SCHOOLCRAFT RD
Address2:  
City: LIVONIA
State: MI
PostalCode: 481501216
CountryCode: US
TelephoneNumber: 7344640887
FaxNumber: 7344020254
Practice Location
Address1: 1840 WEALTHY ST SE
Address2: MC426
City: GRAND RAPIDS
State: MI
PostalCode: 495062921
CountryCode: US
TelephoneNumber: 7344640887
FaxNumber: 7344020254
Other Information
ProviderEnumerationDate: 11/14/2011
LastUpdateDate: 08/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164W00000X4704222771MIY Nursing Service ProvidersLicensed Practical Nurse 

No ID Information.


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