Individual
MRS. BRENDA JO WHARTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25 MICHIGAN ST NE, SUITE 3300, GRAND RAPIDS, MI 49503-2515
(616) 459-4171
(616) 459-0044
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004126
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
382285194
TAX ID
MI
Enumeration date
09/25/2006
Last updated
01/30/2024
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