Kelly R Niezurawski, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704187362 Issued in MI

Practice address

6500 N Hawkins Hwy
Manitou Beach, MI 49253-9736

Phone

(734) 572-5777

NPI assigned

Feb 25, 2020

Last updated

Jun 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1992339311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 175",
            "city": "MANITOU BEACH",
            "state": "MI",
            "postal_code": "492530175",
            "telephone_number": "517-403-3771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 N HAWKINS HWY",
            "city": "MANITOU BEACH",
            "state": "MI",
            "postal_code": "492539736",
            "telephone_number": "734-572-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEZURAWSKI",
        "first_name": "KELLY",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-25",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704187362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Manitou Beach, MI
• Providers in Manitou Beach, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.