| NPI | 1669765137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEUNIQUE WILSON Practice Administrator 616-325-7879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2025-02-25 |