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NPI Code Detail

MEDICARE: CHRISTOPHER WOLTERSTORFF M.A.

MEDICARE: CHRISTOPHER WOLTERSTORFF M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1376K00000XNurse's Aide

General Provider Information

NPI Number : 1811247414
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER WOLTERSTORFF M.A.
Provider Business Mailing Address
First Line : 2706 BURTON SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-4927
Country : US
Telephone Number : 616-214-8366
Fax Number : 616-214-8369
Provider Business Practice Location Address
First Line : 2706 BURTON SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-4927
Country : US
Telephone Number : 616-214-8366
Fax Number : 616-214-8369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2012
Last Update Date : 09/12/2012

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