Individual
MRS. LONNA PETRONELLA VAN AST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1022 ADA PLACE DR SE, GRAND RAPIDS, MI 49546-3786
(616) 550-0427
Mailing address
1022 ADA PLACE DR SE, GRAND RAPIDS, MI 49546-3786
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601002990
MI
Other
Enumeration date
07/14/2010
Last updated
07/29/2013
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