Provider Demographics
NPI:1841601341
Name:PROSS, KIM (NURSE)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:PROSS
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:RICHERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE
Mailing Address - Street 1:3007 NORTH SAGINAW ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-633-1400
Mailing Address - Fax:
Practice Address - Street 1:3007 NORTH SAGINAW ROAD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-633-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703104866164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse