Individual
LARYN C KENWABIKISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1221 SIXTH ST STE 300, TRAVERSE CITY, MI 49684-2360
(231) 392-0640
Mailing address
2098 ESSEX VIEW DR APT 205, TRAVERSE CITY, MI 49685-8829
(231) 878-7902
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601012983
MI
363AS0400X
Surgical Physician Assistant
5601012983
MI
Other
Enumeration date
01/18/2025
Last updated
02/05/2025
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