Healthcare Provider Details

I. General information

NPI: 1831330935
Provider Name (Legal Business Name): WISHING WELL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 RODNEY CR. N.E.
GRAND RAPIDS MI
49505
US

IV. Provider business mailing address

1721 RODNEY CR. N.E.
GRAND RAPIDS MI
49505
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-9113
  • Fax:
Mailing address:
  • Phone: 616-363-9113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARILYN V. HEERINGA
Title or Position: HEALTH SERVICE PROVIDER
Credential:
Phone: 616-363-9113