Individual
SUSAN KAY VANDER WEIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
755 36TH ST SE, GRAND RAPIDS, MI 49548-2319
(269) 965-5924
Mailing address
755 36TH ST SE, GRAND RAPIDS, MI 49548-2319
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704307913
MI
Other
Enumeration date
11/23/2021
Last updated
11/23/2021
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