Individual
MALLORY MARTENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503
(616) 391-3431
(616) 391-2783
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007638
MI
Other
Enumeration date
12/29/2015
Last updated
09/01/2021
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