Individual
MARILYN GAIL HUPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1912 LYNNE LN NW, GRAND RAPIDS, MI 49504-6029
(616) 735-1592
Mailing address
1912 LYNNE LN NW, GRAND RAPIDS, MI 49504-6029
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703086473
MI
Other
Enumeration date
04/12/2009
Last updated
04/12/2009
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