Provider Demographics
NPI:1982652483
Name:MCKUNE, ANNE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MCKUNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:813 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2401
Practice Address - Country:US
Practice Address - Phone:517-787-6001
Practice Address - Fax:517-782-2062
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704152445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500024273OtherRR MEDICARE
MI4394905Medicaid
MI4394905Medicaid