| NPI | 1629657259 |
|---|---|
| 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 |