Provider Demographics
NPI:1649603754
Name:KOTTUKAPPALLY, ANU JOHN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANU
Middle Name:JOHN
Last Name:KOTTUKAPPALLY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5066
Mailing Address - Country:US
Mailing Address - Phone:248-633-6339
Mailing Address - Fax:
Practice Address - Street 1:3801 EVERETT DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5066
Practice Address - Country:US
Practice Address - Phone:248-633-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704262830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily