NPI 1083623128 · live from the CMS NPI Registry
Kathleen Buller, NP
Nurse Practitioner, Pediatrics in Grand Rapids, MI. National Provider Identifier 1083623128, active.
NPI record
| NPI | 1083623128 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 730 Grandville Ave Sw, Grand Rapids, MI 49503 |
| Practice phone | 616-913-8400 |
| Mailing address | 245 State St Se, Grand Rapids, MI 49503 |
| Enumerated | August 7, 2006 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 4704096205 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.