Individual
KATHLEEN KUBACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1853 R W BERENDS DR SW, WYOMING, MI 49519-4955
(616) 534-9300
Mailing address
3583 KIEL ST, HUDSONVILLE, MI 49426-1307
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703116155
MI
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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