Healthcare Provider Details

I. General information

NPI: 1285050435
Provider Name (Legal Business Name): MS. GRACE AUDREY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-6844
US

IV. Provider business mailing address

2824 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-6844
US

V. Phone/Fax

Practice location:
  • Phone: 616-822-1408
  • Fax:
Mailing address:
  • Phone: 616-822-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: