Provider Demographics
NPI:1649948324
Name:KUIPER, JUSTEENA
Entity type:Individual
Prefix:
First Name:JUSTEENA
Middle Name:
Last Name:KUIPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUSTEENA
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4773 US HIGHWAY 131 N
Mailing Address - Street 2:
Mailing Address - City:BOYNE FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49713-9617
Mailing Address - Country:US
Mailing Address - Phone:231-633-4355
Mailing Address - Fax:
Practice Address - Street 1:4773 US HIGHWAY 131 N
Practice Address - Street 2:
Practice Address - City:BOYNE FALLS
Practice Address - State:MI
Practice Address - Zip Code:49713-9617
Practice Address - Country:US
Practice Address - Phone:231-633-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704350292163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse