Provider Demographics
NPI:1619373412
Name:BETH-HINDERLITER, KARI
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:BETH-HINDERLITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 MAIN ST
Mailing Address - Street 2:PO BOX 307
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1141
Mailing Address - Country:US
Mailing Address - Phone:989-635-4000
Mailing Address - Fax:989-635-4056
Practice Address - Street 1:5988 STATE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MI
Practice Address - Zip Code:48741
Practice Address - Country:US
Practice Address - Phone:989-683-2221
Practice Address - Fax:877-569-9211
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704280903363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G66499Medicare PIN