Healthcare Provider Details

I. General information

NPI: 1336646934
Provider Name (Legal Business Name): PAMELA LYNNE KUZERA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17600 RYAN RD
DETROIT MI
48212-1155
US

IV. Provider business mailing address

17138 SHINNECOCK DR
MACOMB MI
48042-6204
US

V. Phone/Fax

Practice location:
  • Phone: 313-368-3200
  • Fax:
Mailing address:
  • Phone: 586-207-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704195612
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: