Healthcare Provider Details

I. General information

NPI: 1619342987
Provider Name (Legal Business Name): MS. LILA CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 GRACELAND ST NE
GRAND RAPIDS MI
49505-6252
US

IV. Provider business mailing address

1939 S DIVISION AVE.
GRAND RAPIDS MI
49507
US

V. Phone/Fax

Practice location:
  • Phone: 231-360-7791
  • Fax:
Mailing address:
  • Phone: 616-247-3815
  • Fax: 616-245-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: