Individual
GREG ALLEN BOOTH VANDER WEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
470 BALTIMORE DR NE, GRAND RAPIDS, MI 49503-3934
(616) 726-1909
Mailing address
470 BALTIMORE DR NE, GRAND RAPIDS, MI 49503-3934
(616) 726-1909
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703114773
MI
Other
Enumeration date
07/12/2021
Last updated
07/12/2021
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