Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Jul 19, 2006
License(s)
4704163017 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 428 | Cadillac, MI 49601-0428 | 231-775-6076 |
| LOCATION | 110 WASHINGTON ST | Manistee, MI 49660-1233 | 231-723-9190 |
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