Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 7501002608 | MI |
NPI | 1861940686 |
---|---|
Provider Name | Lisa Olmetti-O'loughlin |
First Address | Grand Rapids, MI 49506-5228 |
Second Address | Grand Rapids, MI 49506-2762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2016 |
Last Update Date | 21/09/2016 |