Individual
DEANNA NICOLE BAZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 36TH ST SE, GRAND RAPIDS, MI 49512-2810
(616) 942-2110
Mailing address
931 SHADYBROOK DR, HOLLAND, MI 49424-1600
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B250139630787
NONE
MI
Enumeration date
01/24/2021
Last updated
01/24/2021
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