Individual
JENNIFER LYNN VANDER BOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
927 INNES ST NE, GRAND RAPIDS, MI 49503
(231) 629-1445
Mailing address
927 INNES ST NE, GRAND RAPIDS, MI 49503-3519
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
8120118
MI
Other
Enumeration date
04/13/2018
Last updated
04/13/2018
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