Individual
KRISTIE KOCZENASZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC
Contact information
Practice address
5701 BOW POINTE DR, SUITE 280, CLARKSTON, MI 48346-3198
(248) 922-6833
(248) 922-6831
Mailing address
5701 BOW POINTE DR, SUITE 280, CLARKSTON, MI 48346-3198
(248) 922-6833
(248) 922-6831
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704230739
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5193320
—
MI
05
—
5193349
—
MI
05
—
5193358
—
MI
01
—
CH3766
RAILROAD MEDICARE GROUP
MI
01
—
KK230739
BLUE CROSS BLUE SHIELD
MI
Enumeration date
11/16/2006
Last updated
08/30/2010
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