Provider Demographics
NPI:1598380081
Name:KOTERBA, KAITLIN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:
Last Name:KOTERBA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:44344 DEQUINDRE RD UNIT 510
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-323-6300
Mailing Address - Fax:
Practice Address - Street 1:44344 DEQUINDRE RD UNIT 510
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-323-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704342342163WP0200X, 363LP0200X
MI202017177363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics