Individual
MISS LYNN ELLEN SOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
900 S BEACON BLVD, GRAND HAVEN, MI 49417-2146
(616) 846-1850
Mailing address
12054 LAKESHORE DR, GRAND HAVEN, MI 49417-9344
(616) 850-3953
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5201004517
MI
Other
Enumeration date
09/11/2009
Last updated
09/11/2009
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