Individual
LAURA HAIST BOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
221 MICHIGAN ST NE STE 300, GRAND RAPIDS, MI 49503-2537
(616) 459-7258
(616) 459-5125
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601007092
MI
Other
Enumeration date
08/27/2014
Last updated
03/09/2022
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