Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | MI |
NPI | 1043742216 |
---|---|
Provider Name | Norise Edwards |
First Address | Grand Rapids, MI 49506-4336 |
Second Address | Grand Rapids, MI 49506-4336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 28/03/2017 |