Provider Demographics
NPI:1255717831
Name:KAMINSKI, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 FITZHUGH DR
Mailing Address - Street 2:APT 10
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5655
Mailing Address - Country:US
Mailing Address - Phone:231-944-2705
Mailing Address - Fax:
Practice Address - Street 1:851 FITZHUGH DR
Practice Address - Street 2:APT 10
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5655
Practice Address - Country:US
Practice Address - Phone:231-944-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIK552461209929390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program