Healthcare Provider Details

I. General information

NPI: 1730967225
Provider Name (Legal Business Name): KATI LOUISE PAFFHAUSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 COLDBROOK ST NE
GRAND RAPIDS MI
49503-1008
US

IV. Provider business mailing address

2122 SANDSTONE DR
JENISON MI
49428-7729
US

V. Phone/Fax

Practice location:
  • Phone: 616-200-8495
  • Fax:
Mailing address:
  • Phone: 616-334-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704285880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: