Individual
MR. MARK N ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
17160 130TH AVE, NUNICA, MI 49448-9450
(616) 847-4460
(616) 847-4467
Mailing address
17160 130TH AVE, NUNICA, MI 49448-9450
(616) 847-4460
(616) 847-4467
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/19/2007
Last updated
10/19/2007
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