Individual
CONNIE M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3290 N WELLNESS DR STE 240, HOLLAND, MI 49424-7261
(616) 395-9379
(616) 820-1457
Mailing address
3290 N WELLNESS DR STE 240, HOLLAND, MI 49424-7261
(616) 395-9379
(616) 820-1457
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
5601002814
MI
363A00000X
Physician Assistant
Primary
5601002814
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1941713
—
MI
Enumeration date
09/07/2005
Last updated
07/18/2024
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