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General NPI Number Information
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NPI Number | 1184734576
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Entity Type | Organization
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Legal Business Name | MARILYN VIERA MSW DO PLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1515 LAKE LANSING RD SUITE C-1
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City | LANSING
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State | MI
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Zip | 48912-3753
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Country | US
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Telephone | 517-482-8735
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Fax | 517-482-8744
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Provider Business Mailing Address
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Address Line | 1515 LAKE LANSING RD SUITE C-1
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City | LANSING
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State | MI
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Zip | 48912-3753
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Country | US
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Telephone | 517-482-8735
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAILYN VIERA
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Credential | MSW DO
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Telephone | 517-482-8735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101011017
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License Number State | MI
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