Individual
LARA GAVALDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6227 FRANKFORT HWY, BENZONIA, MI 49616-8632
(231) 882-9661
Mailing address
6227 FRANKFORT HWY, BENZONIA, MI 49616-8632
(231) 882-9661
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009763
MI
Other
Enumeration date
01/09/2020
Last updated
06/11/2020
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