Individual
MRS. GWEN LEE RUBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
175 E ADAMS ST, IONIA, MI 48846-1672
(616) 527-3340
Mailing address
425 CHERRY ST SE, GRAND RAPIDS, MI 49503-4601
(616) 774-7005
(616) 774-0516
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
4704109915
MI
Other
Enumeration date
10/10/2006
Last updated
07/17/2014
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