Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301406769 | MI |
NPI | 1013023456 |
---|---|
Provider Name | Lisa Anne Andersson-Zetye |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49525-8614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 24/02/2021 |