Provider Demographics
NPI:1336646934
Name:KUZERA, PAMELA LYNNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNNE
Last Name:KUZERA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17138 SHINNECOCK DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-6204
Mailing Address - Country:US
Mailing Address - Phone:586-207-6398
Mailing Address - Fax:
Practice Address - Street 1:17600 RYAN RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1155
Practice Address - Country:US
Practice Address - Phone:313-368-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily