Individual
MARY JO RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
245 CHERRY ST SE, SUITE 204, GRAND RAPIDS, MI 49503-4607
(616) 685-3330
(616) 685-3349
Mailing address
245 CHERRY ST SE, SUITE 204, GRAND RAPIDS, MI 49503-4607
(616) 685-3330
(616) 685-3349
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704131250
MI
Other
Enumeration date
07/16/2012
Last updated
06/26/2015
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