Individual
MRS. ALICIA MAY MANCINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4100 LAKE DR SE, SUITE 205, GRAND RAPIDS, MI 49546-8292
(616) 267-7100
(616) 267-7102
Mailing address
100 MICHIGAN ST NE, MC-845, GRAND RAPIDS, MI 49503-2560
(616) 267-7100
(616) 267-7102
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
002477
CT
363AS0400X
Surgical Physician Assistant
Primary
5601007930
MI
Other
Enumeration date
09/29/2010
Last updated
12/19/2016
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