Individual
LISA JANE EALY CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 MICHIGAN ST NE, SUITE A721, GRAND RAPIDS, MI 49503-2560
(616) 391-3139
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006950
MI
Other
Enumeration date
04/02/2014
Last updated
02/22/2021
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