Provider Demographics
NPI:1245350099
Name:HOBSON, KATRINA HAZEL-RENEE (CNP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:HAZEL-RENEE
Last Name:HOBSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1065
Mailing Address - Country:US
Mailing Address - Phone:248-802-2848
Mailing Address - Fax:
Practice Address - Street 1:6000 FREEDOM SQUARE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2577
Practice Address - Country:US
Practice Address - Phone:947-209-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036283363LA2200X
DELP-0010726363LA2200X
CT13064363LA2200X
AZ267996363LA2200X
MIA0405092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1245350099Medicaid
MI50086781400OtherBCBS IND
MI50086781400OtherBCBS IND