Individual
MRS. LISA ANN MERVENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
2520 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49504-4696
(616) 735-6050
Mailing address
4075 SILVERGRASS DR NE, GRAND RAPIDS, MI 49525-9552
(616) 447-0102
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5201000452
MI
Other
Enumeration date
10/05/2007
Last updated
10/05/2007
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