Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 4704186427 | MI |
NPI | 1336442912 |
---|---|
Provider Name | Kelly J Kurin |
First Address | Carol Stream, IL 60122-4602 |
Second Address | Marquette, MI 49855-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2010 |
Last Update Date | 21/12/2010 |