Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704264031 | MI |
NPI | 1003275777 |
---|---|
Provider Name | Chantelle Remenak |
First Address | Kalamazoo, MI 49009-9538 |
Second Address | Kalamazoo, MI 49009-9538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2016 |
Last Update Date | 26/01/2021 |