Provider Demographics
NPI:1811247414
Name:WOLTERSTORFF, CHRISTOPHER (MA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WOLTERSTORFF
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 BURTON SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4927
Mailing Address - Country:US
Mailing Address - Phone:616-214-8366
Mailing Address - Fax:616-214-8369
Practice Address - Street 1:2706 BURTON SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4927
Practice Address - Country:US
Practice Address - Phone:616-214-8366
Practice Address - Fax:616-214-8369
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide