Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101025735 | MI |
NPI | 1083149173 |
---|---|
Provider Name | Mrs. Madeline Janelle Ginn-Terpstra |
First Address | East Lansing, MI 48824-7015 |
Second Address | Grand Rapids, MI 49525-7069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 04/06/2021 |