Individual
MS. MARY ANN VANDERLUGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9756
(616) 364-4200
(616) 364-7347
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9756
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704128214
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4299352
—
MI
Enumeration date
08/22/2006
Last updated
07/03/2014
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