Individual
MARYANN MICHELLE LAVENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5633 EMBASSY ST, KALAMAZOO, MI 49009-6499
(269) 341-3195
Mailing address
5633 EMBASSY ST, KALAMAZOO, MI 49009-6499
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
AS390400275
MI
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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