Individual
ANNELISE ELIZABETH MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 940-0040
Mailing address
4393 DIVISION ST, WAYLAND, MI 49348-9786
(269) 397-0527
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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