Healthcare Provider Details

I. General information

NPI: 1639951833
Provider Name (Legal Business Name): KATHLEEN DOBBS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22631 GREATER MACK AVE STE 100
SAINT CLAIR SHORES MI
48080-2055
US

IV. Provider business mailing address

31024 ANGELINE CT E
SAINT CLAIR SHORES MI
48082-1424
US

V. Phone/Fax

Practice location:
  • Phone: 586-800-0086
  • Fax:
Mailing address:
  • Phone: 248-396-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704338826
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: