Individual
LISA JOY VANDERTOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4473 220TH AVE, REED CITY, MI 49677-8593
(231) 832-2247
Mailing address
13907 DELTA DR, BIG RAPIDS, MI 49307-9574
(231) 250-3316
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704270281
MI
Other
Enumeration date
11/17/2022
Last updated
11/17/2022
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