MEDICARE: RENEE KINAIA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	4704266692	MI
2	363L00000X	Nurse Practitioner	4704266692	MI
3	363LA2200X	Adult Health Nurse Practitioner	4704266692	MI

General Provider Information

NPI Number	:	1073028130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE KINAIA NP

Provider Business Mailing Address
First Line	:	2311 15 MILE RD STE A
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4842
Country	:	US
Telephone Number	:	586-354-1489
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 15 MILE RD STE A
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4842
Country	:	US
Telephone Number	:	586-354-1489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	11/09/2020

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