Individual
LISA R PRICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
145 MICHIGAN ST NE STE 3100, GRAND RAPIDS, MI 49503-2563
(616) 954-9800
(616) 954-1724
Mailing address
145 MICHIGAN ST NE STE 3100, GRAND RAPIDS, MI 49503-2563
(616) 954-9800
(616) 954-1724
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601012229
STATE LICENSE
MI
Enumeration date
03/06/2024
Last updated
03/06/2024
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