Provider Demographics
NPI:1750637518
Name:KENYON, ANNETTE (NP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:KENYON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:STEINHAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2111 MERRITT RD
Mailing Address - Street 2:STE 101
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6916
Mailing Address - Country:US
Mailing Address - Phone:517-332-4263
Mailing Address - Fax:517-332-1132
Practice Address - Street 1:2111 MERRITT RD
Practice Address - Street 2:STE 101
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6916
Practice Address - Country:US
Practice Address - Phone:517-332-4263
Practice Address - Fax:517-332-1132
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704298711363LF0000X
WI154858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner