Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704154586 | MI |
NPI | 1043295603 |
---|---|
Provider Name | Terri Lynn Kraft |
First Address | Nashville, TN 37201-1835 |
Second Address | Grand Rapids, MI 49503-2293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4704154586 | CONTROLLED SUBSTANCE (01) | MI |