Provider Demographics
NPI:1578941571
Name:KUKLEWSKI, ANGELA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KUKLEWSKI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8348 LITTLE ROAD
Mailing Address - Street 2:STE 149
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4919
Mailing Address - Country:US
Mailing Address - Phone:616-366-4234
Mailing Address - Fax:855-548-4481
Practice Address - Street 1:600 MONROE AVENUE NW
Practice Address - Street 2:STE 104
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1470
Practice Address - Country:US
Practice Address - Phone:616-366-4234
Practice Address - Fax:855-548-4481
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2024-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704229854363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care