Provider Demographics
NPI:1760659650
Name:BERCHEM, KATHY ANN (RN MSN FNP BC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:BERCHEM
Suffix:
Gender:F
Credentials:RN MSN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-348-9710
Mailing Address - Fax:231-348-9715
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 340
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-348-9710
Practice Address - Fax:231-348-9715
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner