Provider Demographics
NPI:1568030880
Name:KUERTH, KATINA ANN PULOS (DNP)
Entity Type:Individual
Prefix:MS
First Name:KATINA
Middle Name:ANN PULOS
Last Name:KUERTH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 DUFF RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9082
Mailing Address - Country:US
Mailing Address - Phone:231-329-3994
Mailing Address - Fax:
Practice Address - Street 1:2400 S SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-6240
Practice Address - Country:US
Practice Address - Phone:231-329-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252042163W00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse