Provider Demographics
NPI:1730111444
Name:KAMINEN GETZLOFF, DARCY J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:J
Last Name:KAMINEN GETZLOFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-774-1313
Mailing Address - Fax:906-776-5639
Practice Address - Street 1:1721 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-774-1313
Practice Address - Fax:906-776-5639
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01007851OtherPREFERRED ONE
MI4360371Medicaid
MI5008766220OtherBCBS MI
WI43955200Medicaid
MI50021210OtherRR MEDICARE
MI50021210OtherRR MEDICARE
MIP44986Medicare UPIN
WI43955200Medicaid