Provider Demographics
NPI:1952916751
Name:EMILY KINSMAN LLC
Entity Type:Organization
Organization Name:EMILY KINSMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:810-240-0349
Mailing Address - Street 1:11141 WHISPERING RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3409
Mailing Address - Country:US
Mailing Address - Phone:810-240-0349
Mailing Address - Fax:
Practice Address - Street 1:5014 VILLA LINDE PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3411
Practice Address - Country:US
Practice Address - Phone:810-733-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty