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NPI Code Detail

MEDICARE: MARY RUTH GRASSI

MEDICARE: MARY RUTH GRASSI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse4703084387MI

General Provider Information

NPI Number : 1861142119
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY RUTH GRASSI
Provider Business Mailing Address
First Line : 5300 PATTERSON AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-5663
Country : US
Telephone Number : 616-222-5601
Fax Number :
Provider Business Practice Location Address
First Line : 5300 PATTERSON AVE SE STE 125
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9627
Country : US
Telephone Number : 616-222-5601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2022
Last Update Date : 03/28/2022

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Directions to “ MARY RUTH GRASSI ” Practice Location

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