Individual
SHANTEL LYNN BLEEKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, RD
Contact information
Practice address
3304 COOLEY CT, PORTAGE, MI 49024
(269) 349-2266
(269) 349-0792
Mailing address
3304 COOLEY CT, PORTAGE, MI 49024-7430
(269) 349-2266
(269) 349-0792
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007179
MI
Other
Enumeration date
09/19/2014
Last updated
01/21/2019
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