Individual
VICKY LYNN NORRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6105 WILSON AVE SW, GRANDVILLE, MI 49418-9714
(616) 391-2778
(616) 486-5076
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 391-2778
(616) 486-5076
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101011342
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0156910165
BCBSM
MI
01
—
11284828
CAQH PROVIDER ID
—
05
—
1164457917
—
MI
05
—
4606954
—
MI
01
—
700C910950
BCBSM
MI
Enumeration date
07/11/2006
Last updated
07/21/2014
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