Healthcare Provider Details

I. General information

NPI: 1215014667
Provider Name (Legal Business Name): THERESA RUTH KUHR R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 JERUMBO ST
MANISTEE MI
49660-1116
US

IV. Provider business mailing address

318 JERUMBO ST
MANISTEE MI
49660-1116
US

V. Phone/Fax

Practice location:
  • Phone: 231-794-9459
  • Fax: 231-398-3469
Mailing address:
  • Phone: 231-794-9459
  • Fax: 231-398-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704186286
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: