Individual
CLARA VANDERWEIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
730 GRANDVILLE AVE SW, GRAND RAPIDS, MI 49503-4920
(616) 685-8400
Mailing address
1900 44TH ST SE, KENTWOOD, MI 49508-5008
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704293832
MI
Other
Enumeration date
07/07/2015
Last updated
07/07/2015
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