Individual
MARY MANILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7751 BYRON CENTER AVE SW, SUITE C, BYRON CENTER, MI 49315-8001
(616) 267-7668
(616) 267-7941
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704285854
MI
Other
Enumeration date
08/29/2016
Last updated
02/25/2021
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