Individual
KETURA DICKINSON-HENDERSHOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 391-1730
Mailing address
4100 EMBASSY DR SE, GRAND RAPIDS, MI 49546-2416
(616) 988-8220
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601012398
MI
Other
Enumeration date
05/13/2024
Last updated
09/26/2024
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