Basic Information
| Provider Information | |||||||||
| NPI: | 1912383944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUC | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37595 7 MILE RD | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481521003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347932470 | ||||||||
| FaxNumber: | 7347932471 | ||||||||
| Practice Location | |||||||||
| Address1: | 37595 7 MILE RD | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481521003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347932470 | ||||||||
| FaxNumber: | 7347932471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2015 | ||||||||
| LastUpdateDate: | 12/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704240438 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.