MEDICARE: MRS. KATHRYN ROSE WHNP

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	363LW0102X	Women's Health Nurse Practitioner	4704203365	MI

General Provider Information

NPI Number	:	1316164742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN ROSE WHNP

Provider Business Mailing Address
First Line	:	400 RENAISSANCE CTR STE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48243-1599
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 RENAISSANCE CTR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48243-1502
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	11/23/2025

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