Healthcare Provider Details

I. General information

NPI: 1184273062
Provider Name (Legal Business Name): MICHELLE KIEU JOSLYN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ORCHARD VISTA DR SE
GRAND RAPIDS MI
49546-7069
US

IV. Provider business mailing address

3075 ORCHARD VISTA DR SE
GRAND RAPIDS MI
49546-7069
US

V. Phone/Fax

Practice location:
  • Phone: 269-317-3309
  • Fax:
Mailing address:
  • Phone: 269-317-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: