=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730111444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARCY J KAMINEN GETZLOFF FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 07/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1721 S STEPHENSON AVE
-----------------------------------------------------
City | IRON MOUNTAIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49801-3637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-774-1313
-----------------------------------------------------
Fax | 906-776-5639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 549
-----------------------------------------------------
City | IRON MOUNTAIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49801-0549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-774-1313
-----------------------------------------------------
Fax | 906-776-5639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4704210297
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------