Healthcare Provider Details

I. General information

NPI: 1184845455
Provider Name (Legal Business Name): ANGELA ANN MUSSELMAN L.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 68TH ST SE SUITE 300
GRAND RAPIDS MI
49548-6980
US

IV. Provider business mailing address

PO BOX 519
BYRON CENTER MI
49315-0519
US

V. Phone/Fax

Practice location:
  • Phone: 616-292-1995
  • Fax: 616-827-2277
Mailing address:
  • Phone: 616-292-1995
  • Fax: 616-827-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: