MEDICARE: KATHLEEN MARIE KERPERIEN RN/ BSN/ IBCLC

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	163WL0100X	Lactation Consultant (Registered Nurse)	4704102919	MI

General Provider Information

NPI Number	:	1477988020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARIE KERPERIEN RN/ BSN/ IBCLC

Provider Business Mailing Address
First Line	:	3086 TORREY BEACH DRIVE
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430
Country	:	US
Telephone Number	:	586-995-2533
Fax Number	:

Provider Business Practice Location Address
First Line	:	3086 TORREY BEACH DRIVE
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430
Country	:	US
Telephone Number	:	586-995-2533
Fax Number	:

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

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	09/13/2013

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