Individual
RICKIE LYNN HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
48617 36TH AVE, BANGOR, MI 49013-9791
(616) 403-9430
(269) 427-7009
Mailing address
48617 36TH AVE, BANGOR, MI 49013-9791
(616) 403-9430
(269) 427-7009
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
AF800328155
MI
Other
Enumeration date
02/22/2013
Last updated
02/22/2013
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