Lydia Charlene Wollak

NPI #1972155034 in East Grand Rapids, Michigan

Provider Information

NPI Number: 1972155034
Entity Type: Individual
Name: Lydia Charlene Wollak
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician, Other
Enumeration Date: Jul 9, 2019
Last Updated: Jan 18, 2024

Practice Location

Address: 2814 WOODCLIFF CIR SE
City: East Grand Rapids
State: Michigan
ZIP Code: 49506-3155
Phone: (855) 832-6727

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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