Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301100233 | MI |
N | 207QS0010X | Family Doctor - Sports Medicine | 4301100233 | MI |
NPI | 1093943771 |
---|---|
Provider Name | Courtney Erickson-Adams |
First Address | Holland, MI 49423-7724 |
Second Address | Holland, MI 49423-7724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 19/07/2021 |