NPI | 1629656251 |
---|---|
Entity Type | Organization |
Authorized Contact | ELISABETH LACEY Credentialing Manager 616-486-6630 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine |
Additional Taxonomies | 363L00000X Nurse Practitioner |
Enumeration Date | 2021-04-02 |
Last Update Date | 2021-04-02 |