Individual
LAUREN MARIE WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4069 LAKE DR SE STE 315, GRAND RAPIDS, MI 49546-8816
(616) 267-7758
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008976
MI
Other
Enumeration date
11/08/2018
Last updated
02/23/2021
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