Individual
HOLLY N. FIDDLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
230 MICHIGAN ST NE, SUITE 300, GRAND RAPIDS, MI 49503-2550
(616) 459-7101
(616) 459-8425
Mailing address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
(616) 954-6483
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006528
MI
363AS0400X
Surgical Physician Assistant
5601006528
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OD14869
GROUP PTAN
—
Enumeration date
11/28/2012
Last updated
05/05/2014
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