Individual
AUDREY MACCIOMEI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
630 KENMOOR AVE SE STE 103, GRAND RAPIDS, MI 49546-8626
(616) 600-4950
Mailing address
1023 HELEN ST NE UNIT 1, GRAND RAPIDS, MI 49503-3670
(331) 999-5493
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601012216
MI
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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