Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | JE013840 | MI |
NPI | 1851355655 |
---|---|
Provider Name | Dr. Jeanne Eyde |
First Address | Grand Rapids, MI 49506-4810 |
Second Address | Wyoming, MI 49519-6439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 23/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1851355655 | (05) | MI |
I14939 | (02) | MI |