Healthcare Provider Details

I. General information

NPI: 1073246138
Provider Name (Legal Business Name): KAY SUSAN BARANCZYK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY SUSAN HARTMAN APNP

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 10TH AVE
MENOMINEE MI
49858-3058
US

IV. Provider business mailing address

301 EXPLORER ST
GWINN MI
49841-2813
US

V. Phone/Fax

Practice location:
  • Phone: 906-290-5000
  • Fax: 906-372-3230
Mailing address:
  • Phone: 906-290-5000
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704423090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: