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Individual

KATHLEEN MARIE PAWLANTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
F.N.P.

Contact information

Practice address
829 N CENTER AVE, SUITE 210, GAYLORD, MI 49735-1595
(989) 731-7860
(989) 731-7954
Mailing address
829 N CENTER AVE, SUITE 298, GAYLORD, MI 49735-1595
(989) 731-7708
(989) 731-7929

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704196460
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
381303843
TAX ID
05
4600629
MI
01
DC6258
MEDICARE RR PROV ID
01
OF96004
MEDICARE GROUP NUMBER
Enumeration date
07/17/2006
Last updated
12/23/2020
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