1073246138 NPI number — MS. KAY SUSAN BARANCZYK APNP

Table of content: MS. KAY SUSAN BARANCZYK APNP (NPI 1073246138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073246138 NPI number — MS. KAY SUSAN BARANCZYK APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARANCZYK
Provider First Name:
KAY
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTMAN
Provider Other First Name:
KAY
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073246138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 EXPLORER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GWINN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49841-2813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-290-5000
Provider Business Mailing Address Fax Number:
906-372-3230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENOMINEE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49858-3058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-290-5000
Provider Business Practice Location Address Fax Number:
906-372-3230
Provider Enumeration Date:
07/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704423090 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F06220244 . This is a "AANP" identifier . This identifiers is of the category "OTHER".




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