Provider Demographics
NPI:1568472538
Name:KASPOR, ANNELLE (RN,MPH,FNP-C)
Entity Type:Individual
Prefix:
First Name:ANNELLE
Middle Name:
Last Name:KASPOR
Suffix:
Gender:F
Credentials:RN,MPH,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 W FRONT ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7941
Mailing Address - Country:US
Mailing Address - Phone:231-935-8930
Mailing Address - Fax:
Practice Address - Street 1:3537 W FRONT ST
Practice Address - Street 2:SUITE E
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7941
Practice Address - Country:US
Practice Address - Phone:231-935-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAK110709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR67665Medicare UPIN
MION85920Medicare ID - Type UnspecifiedMEDICARE GROUP#