Individual
MS. HOLLY J SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
2221 HEALTH DR SW STE 2100, WYOMING, MI 49519-9650
(616) 252-4100
(616) 252-4480
Mailing address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003909
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970030440
RAILROAD MEDICARE
MI
Enumeration date
02/13/2006
Last updated
02/13/2019
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