Individual
MRS. LAURA EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 281-6360
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 281-6360
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704211246
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704211246
MI
Other
Enumeration date
01/18/2012
Last updated
11/10/2014
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