Individual
KENLYN MARIE LAUREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3900 HOLLYWOOD RD, SAINT JOSEPH, MI 49085-9149
(269) 428-4411
Mailing address
100 E WAYNE ST STE 510, SOUTH BEND, IN 46601-2394
(574) 334-5400
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704266783
MI
363LF0000X
Family Nurse Practitioner
71009215A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71009215A
STATE LICENSE
IN
Enumeration date
09/10/2014
Last updated
05/17/2021
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