Individual provider · Type 1 NPI

Kallie Rae Kraker

Primary Care Nurse Practitioner · Grand Rapids, MI

NPI number 1578065140 Active

Practice location

4118 Kalamazoo Ave SE
Grand Rapids, MI 49508-3605

Mailing address

1809 Edgewood Ave SE
Grand Rapids, MI 49506-5112

Specialties and licenses

TaxonomyCodeLicense
Primary Care Nurse Practitioner Primary 363LP2300X4704280159 (MI)

Primary Care Nurse Practitioner: Definition to come...

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About NPI 1578065140

Kallie Rae Kraker's National Provider Identifier is 1578065140, issued on Feb 28, 2018. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Grand Rapids, MI. The record was last updated on Feb 28, 2018.