Individual
LISA ANN WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1545 68TH ST SE STE 100, GRAND RAPIDS, MI 49508-7896
(616) 267-7881
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704265502
MI
Other
Enumeration date
09/05/2013
Last updated
02/19/2021
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