Provider Demographics
NPI:1558343947
Name:KIRCHNER, KATHLEEN D (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N10565 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1500
Mailing Address - Fax:906-932-5630
Practice Address - Street 1:N10565 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-1500
Practice Address - Fax:906-932-5091
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704153747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41269100Medicaid
1045641OtherPREFERREDONE
MI4788543Medicaid
MN429G6KIOtherBCBS
MN429G6KIOtherBCBS
WI41269100Medicaid
MI004Medicare PIN