Provider Demographics
NPI:1669439758
Name:METCALF, KATHERINE GRINENKO (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:GRINENKO
Last Name:METCALF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:GRINENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2255 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2671
Mailing Address - Country:US
Mailing Address - Phone:313-386-7500
Mailing Address - Fax:313-386-6447
Practice Address - Street 1:2255 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2671
Practice Address - Country:US
Practice Address - Phone:313-386-7500
Practice Address - Fax:313-386-6447
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN278072363L00000X
OHCOANP06837363L00000X
OHRX06837363L00000X
MI4704190296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner