Doctor Name: | KATHERINE ANNE REPP |
NPI Number: | 1023465010 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 4704285347 |
Business Practice Address: | 18181 Oakwood Blvd Suite 101 Dearborn, MI - 481245032 |
Business Phone Number: | 3134362426 |
Business Fax Number: | |
Mailing Address: | 18181 Oakwood Blvd, Suite 101 DEARBORN |
State: | MI |
Postal Code: | 481245032 |
Phone Number: | 3134362426 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2016 |
NPI Last Update Date: | 05/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | 4704285347 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |