Individual
MARY JEAN DEGRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(906) 774-1313
Mailing address
E21892 CROOKED LAKE RD, WATERSMEET, MI 49969-9740
(906) 285-2605
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704236417
MI
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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