Provider Demographics
NPI:1144242371
Name:KAISER, MARY E (MSN, NP-C, CWOCN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:KAISER
Suffix:
Gender:F
Credentials:MSN, NP-C, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SHAFFER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1647
Mailing Address - Country:US
Mailing Address - Phone:269-552-0014
Mailing Address - Fax:269-552-0014
Practice Address - Street 1:601 JOHN ST STE W-308
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5357
Practice Address - Country:US
Practice Address - Phone:269-341-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704166661363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73227731Medicaid
MI4859242Medicaid
MI4859242Medicaid
CO73227731Medicaid