Individual
MARY R KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
610 S LINCOLN RD, ESCANABA, MI 49829-1215
(906) 786-6488
(906) 786-6409
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
246069-30
WI
163W00000X
Registered Nurse
4704305878
MI
363LF0000X
Family Nurse Practitioner
4704305878
MI
363LF0000X
Family Nurse Practitioner
Primary
9045-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F09181074
AMERICAN ACADEMY OF NURSE PRACTITIONERS
—
Enumeration date
01/25/2019
Last updated
11/09/2020
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