Individual
LYDIA CHARLENE WOLLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2814 WOODCLIFF CIR SE, EAST GRAND RAPIDS, MI 49506-3155
(855) 832-6727
Mailing address
154 W 33RD ST, HOLLAND, MI 49423-7106
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247200000X
—
MI
Enumeration date
07/09/2019
Last updated
01/18/2024
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