Kim Amon

Individual provider Active NPI Licensed Practical Nurse · Davison, MI

NPI 1710381520 · NPPES record last updated Oct 22, 2014

Key facts

NPI
1710381520
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
4703040539 (MI)
Practice address
7175 Timberwood Dr
Davison, MI 48423-9550
Phone
(810) 845-9195
NPI assigned
Oct 22, 2014
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
4703040539MIMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 4703040539 MI Yes

Addresses

Primary practice location

7175 Timberwood Dr
Davison, MI 48423-9550

Mailing address

7175 Timberwood Dr
Davison, MI 48423-9550
Phone (810) 845-9195

Other providers in Davison, MI

All providers in Davison, MI · Licensed Practical Nurse in Michigan

Sources for this page

Verify at the official NPI Registry.