Provider Demographics
NPI:1952337354
Name:BELONGA, KATHY CAROLINE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:CAROLINE
Last Name:BELONGA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 N ISABELLA RD
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9186
Mailing Address - Country:US
Mailing Address - Phone:989-497-2500
Mailing Address - Fax:989-386-8139
Practice Address - Street 1:11775 N ISABELLA RD
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9186
Practice Address - Country:US
Practice Address - Phone:989-497-2500
Practice Address - Fax:989-386-8139
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704142165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily