Healthcare Provider Details

I. General information

NPI: 1477333904
Provider Name (Legal Business Name): MICHELLE RAYANN KUZMA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E LANSING DR STE 107
EAST LANSING MI
48823-7788
US

IV. Provider business mailing address

6016 S MLK BLVD
LANSING MI
48911-4604
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-8881
  • Fax:
Mailing address:
  • Phone: 517-648-3684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704192350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: