Individual
MARY TIBBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN RN CCRN-K AGCNS
Contact information
Practice address
100 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2560
(616) 520-1135
Mailing address
18901 W KIMBALL RD, PIERSON, MI 49339-9605
Taxonomy
Speciality
Code
Description
License number
State
364SG0600X
Gerontology Clinical Nurse Specialist
Primary
4704270663
MI
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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