Provider Demographics
NPI:1932250206
Name:PAQUETTE, KATHERINE ANNE (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANNE
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:KOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:43421 GARFIELD STE 1
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-741-5911
Mailing Address - Fax:586-741-5914
Practice Address - Street 1:17000 E. 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-563-5555
Practice Address - Fax:586-563-1778
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201256363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932250206OtherI HAVE NEVER BILLED AND DO NOT KNOW WHAT TO PU IN FOR IDENTIFICATION NUMBER