Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1114165214 |
---|---|
Provider Name | Judy Essenberg |
First Address | Grand Rapids, MI 49546-2444 |
Second Address | Grand Rapids, MI 49546-8816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2009 |
Last Update Date | 27/01/2009 |