Organization
GREAT LAKES HEARING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY RAE FAASSE' (OWNER)
(616) 988-4327
Entity
Organization
Contact information
Practice address
6272 28TH ST SE, GRAND RAPIDS, MI 49546-6902
(616) 988-4327
(616) 988-9070
Mailing address
6272 28TH ST SE, GRAND RAPIDS, MI 49546-6902
(616) 988-4327
(616) 988-9070
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
3501000421
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004271683
—
MI
Enumeration date
01/09/2007
Last updated
08/22/2020
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