Provider Demographics
NPI:1639920267
Name:RAFFERTY, MEREDITH ANN
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12819 YOST ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9012
Mailing Address - Country:US
Mailing Address - Phone:616-292-1474
Mailing Address - Fax:
Practice Address - Street 1:12819 YOST ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9012
Practice Address - Country:US
Practice Address - Phone:616-292-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care