Healthcare Provider Details

I. General information

NPI: 1508234162
Provider Name (Legal Business Name): KATHERINE WINDRIM PMHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE KRAJICEK PMHNP-BC, RN

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 TOWN CENTER DR
CLARKSTON MI
48346-4824
US

IV. Provider business mailing address

6549 TOWN CENTER DR
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-6400
  • Fax:
Mailing address:
  • Phone: 248-620-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704272980
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: