Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 231108 | MI |
NPI | 1205497443 |
---|---|
Provider Name | Maria Fernanda Winters |
First Address | Grand Rapids, MI 49544-1631 |
Second Address | Grand Rapids, MI 49544-1631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 18/12/2019 |