Individual
MRS. JACKIE LEA MAIVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1853 R W BERENDS DR SW, WYOMING, MI 49519
(616) 534-9300
Mailing address
1853 R. W. BERENDS DR SW, WYOMING, MI 49519-4955
(616) 534-9300
(616) 534-9303
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703029307
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4703029307
—
MI
Enumeration date
06/13/2018
Last updated
07/26/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us