Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301096518 | MI |
Y | 207V00000X | Obstetrician & Gynecologist | MD-41703 | IA |
NPI | 1003128471 |
---|---|
Provider Name | Erin Michelle Fricke |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 11/03/2021 |