Individual
TIJUNAE DIANE OTTERBRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4218 BURTON ST SE, GRAND RAPIDS, MI 49546-6121
(616) 940-0040
Mailing address
4218 BURTON ST SE, GRAND RAPIDS, MI 49546-6121
(616) 940-0040
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
MI000059116
MI
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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