Individual
CHEYENNE ALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4218 BURTON ST SE, GRAND RAPIDS, MI 49546-6121
(717) 454-5209
Mailing address
4218 BURTON ST SE, GRAND RAPIDS, MI 49546-6121
(717) 454-5209
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
MI
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
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