Individual
JENNIFER LYNN VACCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
401 HALL ST SW STE 263, GRAND RAPIDS, MI 49503-4988
(616) 719-0919
(616) 719-0933
Mailing address
401 HALL ST SW STE 263, GRAND RAPIDS, MI 49503-4988
(616) 719-0919
(616) 719-0933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301511266
MI
207R00000X
Internal Medicine Physician
48229
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95951229
—
CO
Enumeration date
08/21/2007
Last updated
04/29/2024
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