Individual
STACEY TUBERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
25 MICHIGAN ST NE, SUITE 6100, GRAND RAPIDS, MI 49503-2515
(616) 267-7900
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704262974
MI
Other
Enumeration date
09/26/2016
Last updated
02/28/2017
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