Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801081709 | MI |
NPI | 1003187584 |
---|---|
Provider Name | Michele A. Virva |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-4224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2012 |
Last Update Date | 18/12/2013 |