MEDICARE: MRS. KATHERINE ANN CALKINS FNP

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	363LF0000X	Family Nurse Practitioner	L181118	MI

General Provider Information

NPI Number	:	1255748562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE ANN CALKINS FNP

Provider Business Mailing Address
First Line	:	15990 W 9 MILE RD
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-4826
Country	:	US
Telephone Number	:	248-849-5692
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 TUXEDO ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1222
Country	:	US
Telephone Number	:	313-865-0576
Fax Number	:

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

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	07/18/2014

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