Provider Demographics
NPI:1245435353
Name:MULDER, KATHI LYNNE (CPM LM)
Entity type:Individual
Prefix:
First Name:KATHI
Middle Name:LYNNE
Last Name:MULDER
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3148
Mailing Address - Country:US
Mailing Address - Phone:231-929-3563
Mailing Address - Fax:
Practice Address - Street 1:537 S GARFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3484
Practice Address - Country:US
Practice Address - Phone:231-929-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000032176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife