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1326715202
SHANA GOETTING BROXUP
GRAND RAPIDS, MI
NPI
1326715202
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: MI 5601010535TMP21)
Enumeration Date
2021-08-27
Last Update Date
2021-08-27
Business Address
SHANA GOETTING BROXUP PA
3230 EAGLE PARK DR NE STE 100
GRAND RAPIDS, MI 49525-7047
Phone number: 616-988-2229
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Mailing Address
SHANA GOETTING BROXUP PA
8550 MOUNTAIN PINE LN
KALAMAZOO, MI 49009-4992
Phone number: 517-896-9426
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