Healthcare Provider Details

I. General information

NPI: 1699426478
Provider Name (Legal Business Name): SHERRY LYNN KURZYM NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 COMMERCE DR STE 100
FORT GRATIOT MI
48059-3868
US

IV. Provider business mailing address

PO BOX 639295
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 810-364-5050
  • Fax:
Mailing address:
  • Phone: 248-824-6032
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704219565
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: