Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301037976 | MI |
NPI | 1154349587 |
---|---|
Provider Name | Gwendolyn L Hoffman |
First Address | Grand Rapids, MI 49501-3536 |
Second Address | Grand Rapids, MI 49503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |