Healthcare Provider Details

I. General information

NPI: 1841285905
Provider Name (Legal Business Name): HELEN KATHERINE KUCH-KUNICH CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR 9TH FLOOR C.S. MOTT CHILDREN'S HOSP
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-5302
  • Fax: 734-763-7728
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704146788
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNP01207
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: