Individual
ALISON ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 ROTH ST SE, GRAND RAPIDS, MI 49548
(616) 340-2416
Mailing address
103 ROTH ST SE, GRAND RAPIDS, MI 49548
(616) 340-2416
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0038627009
—
MI
Enumeration date
10/06/2016
Last updated
10/06/2016
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