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NPI Code Detail

MEDICARE: DR. JOSEPHINE M KAMENDAT FNP -C

MEDICARE: DR. JOSEPHINE M KAMENDAT FNP -C
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
1363LF0000XFamily Nurse Practitioner4704239237NSA18322MI

General Provider Information

NPI Number : 1801387592
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPHINE M KAMENDAT FNP -C
Provider Business Mailing Address
First Line : 6141 STATE RD
Second Line :
City : BURTCHVILLE
State : MI
Zip : 48059-2420
Country : US
Telephone Number : 810-874-6116
Fax Number :
Provider Business Practice Location Address
First Line : 4071 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3801
Country : US
Telephone Number : 810-824-4222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2018
Last Update Date : 05/29/2018

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