Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101026298 | MI |
NPI | 1003309345 |
---|---|
Provider Name | Lauren J Verstraete |
First Address | Beaver Falls, PA 15010-4426 |
Second Address | South Haven, MI 49090-6743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 08/07/2021 |