Individual
MRS. LACEY LEE CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
25 MICHIGAN ST NE STE 6200, GRAND RAPIDS, MI 49503-2577
(616) 391-3304
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005668
MI
Other
Enumeration date
11/10/2009
Last updated
11/06/2023
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