Healthcare Provider Details

I. General information

NPI: 1174632012
Provider Name (Legal Business Name): KIMBERLY RUTH ANDERSON R.N., C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY RUTH NOREEN R.N., C-FNP

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 SOUTH LEATON ROAD
MOUNT PLEASANT MI
48858
US

IV. Provider business mailing address

2591 SOUTH LEATON ROAD
MOUNT PLEASANT MI
48858
US

V. Phone/Fax

Practice location:
  • Phone: 989-775-4605
  • Fax: 989-775-4680
Mailing address:
  • Phone: 989-775-4605
  • Fax: 989-775-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704227621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: