Individual
STACEY ANDRESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 EXPLORER ST, GWINN, MI 49841-2813
(906) 346-9275
Mailing address
2815 WRIGHT ST, MARQUETTE, MI 49855-9694
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902011657
MI
Other
Enumeration date
05/11/2018
Last updated
05/11/2018
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