Provider Demographics
NPI:1730967225
Name:PAFFHAUSEN, KATI LOUISE
Entity type:Individual
Prefix:
First Name:KATI
Middle Name:LOUISE
Last Name:PAFFHAUSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7729
Mailing Address - Country:US
Mailing Address - Phone:616-334-8854
Mailing Address - Fax:
Practice Address - Street 1:49 COLDBROOK ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1008
Practice Address - Country:US
Practice Address - Phone:616-200-8495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily