Provider Demographics
NPI:1972203024
Name:KINAIA, COLLEEN HANNA (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:HANNA
Last Name:KINAIA
Suffix:
Gender:F
Credentials: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 1:624 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1842
Mailing Address - Country:US
Mailing Address - Phone:248-629-7497
Mailing Address - Fax:248-397-8474
Practice Address - Street 1:624 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1842
Practice Address - Country:US
Practice Address - Phone:248-629-7497
Practice Address - Fax:248-397-8474
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2022140880363LF0000X
MI4704323205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily