Provider Demographics
NPI:1114775749
Name:MENARD, KATHERINE IRENE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:IRENE
Last Name:MENARD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CARRIE RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9655
Mailing Address - Country:US
Mailing Address - Phone:517-930-4225
Mailing Address - Fax:
Practice Address - Street 1:1209 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3009
Practice Address - Country:US
Practice Address - Phone:906-273-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240055363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health