Healthcare Provider Details

I. General information

NPI: 1568151470
Provider Name (Legal Business Name): KATHY CROSKEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 N ELMS RD
FLUSHING MI
48433-9423
US

IV. Provider business mailing address

4101 VASSAR ST
DEARBORN HEIGHTS MI
48125-2419
US

V. Phone/Fax

Practice location:
  • Phone: 989-423-0971
  • Fax: 989-393-5960
Mailing address:
  • Phone: 313-409-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704182645
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: