Provider Demographics
NPI:1356730006
Name:VANKIRK, MARIPOSA IRENE (MN, RNC-NIC, NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARIPOSA
Middle Name:IRENE
Last Name:VANKIRK
Suffix:
Gender:F
Credentials:MN, RNC-NIC, NNP-BC
Other - Prefix:MS
Other - First Name:MARIPOSA
Other - Middle Name:IRENE
Other - Last Name:ISAGUIRRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-316-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245024363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal