Individual
STACEY TYRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
980 DIAMOND AVE NE APT 2, GRAND RAPIDS, MI 49503-1290
(815) 603-9826
Mailing address
980 DIAMOND AVE NE APT 2, GRAND RAPIDS, MI 49503-1290
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704403304
MI
Other
Enumeration date
02/17/2025
Last updated
02/17/2025
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