Healthcare Provider Details

I. General information

NPI: 1609093558
Provider Name (Legal Business Name): KATHLEEN P WILLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST
YALE MI
48097-3317
US

IV. Provider business mailing address

116 CLARK AVE
YALE MI
48097
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-4244
  • Fax: 810-387-2605
Mailing address:
  • Phone: 810-387-4244
  • Fax: 810-387-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number080106255627233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: