Individual
CHAD UNDERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.N.
Contact information
Practice address
1450 LEONARD ST NE, GRAND RAPIDS, MI 49505-5515
(616) 446-5101
Mailing address
2809 PORTER ST SW, GRANDVILLE, MI 49418-1144
(616) 446-5101
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703103389
MI
Other
Enumeration date
03/13/2014
Last updated
03/13/2014
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