Provider Demographics
NPI:1831144237
Name:DONTJE, KATHERINE J (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:DONTJE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-2562
Mailing Address - Fax:517-353-2563
Practice Address - Street 1:804 SERVICE RD STE A110
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7015
Practice Address - Country:US
Practice Address - Phone:517-355-2822
Practice Address - Fax:517-355-2824
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704119083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4465981Medicaid
MI4465981Medicaid
MIM618300001Medicare PIN