Individual
LISA VANMAELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
4190 24TH AVE STE 204, FORT GRATIOT, MI 48059-3884
(810) 216-1000
(810) 216-3138
Mailing address
4190 24TH AVE STE 204, FORT GRATIOT, MI 48059-3884
(810) 216-1000
(810) 216-3138
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704155720
MI
Other
Enumeration date
10/15/2013
Last updated
04/08/2021
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