Individual
LAURA WEATHERELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1192 EDNA ST SE, GRAND RAPIDS, MI 49507-3707
(616) 329-9072
Mailing address
1192 EDNA ST SE, GRAND RAPIDS, MI 49507
(616) 329-9072
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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