Healthcare Provider Details

I. General information

NPI: 1952916751
Provider Name (Legal Business Name): EMILY KINSMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 VILLA LINDE PKWY
FLINT MI
48532-3411
US

IV. Provider business mailing address

11141 WHISPERING RIDGE TRL
FENTON MI
48430-3409
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-5450
  • Fax:
Mailing address:
  • Phone: 810-240-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. EMILY J KINSMAN
Title or Position: OWNER
Credential: CRNA
Phone: 810-240-0349