Healthcare Provider Details

I. General information

NPI: 1790369551
Provider Name (Legal Business Name): HEIDI LEE KERN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W SAGINAW ST
LANSING MI
48917-2290
US

IV. Provider business mailing address

3700 W SAGINAW ST
LANSING MI
48917-2290
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-7746
  • Fax:
Mailing address:
  • Phone: 517-321-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704224394
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: