Individual
MARIELLE VANDERVENNEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4288 3 MILE RD NW STE 1, GRAND RAPIDS, MI 49534-7596
(616) 458-3677
Mailing address
4288 3 MILE RD NW STE 1, GRAND RAPIDS, MI 49534-7596
(616) 458-3677
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301111845
MI
Other
Enumeration date
05/16/2017
Last updated
04/02/2024
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