KATHERINE M RADAKOVICH (NPI# 1043330798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043330798 |
| Entity Type | Individual |
| Full Name | KATHERINE M RADAKOVICH |
| Credential | FNP-BC |
| Practice Address |
803 W Arlington St Bangor MI 49013-1108 |
| Practice Telephone | 2694276810 |
| Practice Fax Number | 2694276811 |
| Mailing Telephone | 2694276810 |
| Mailing Fax Number | 2694276811 |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2017-03-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 133V00000X | Dietitian, Registered | 857942 | Dietary & Nutritional Service Providers | |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
4704285987 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
ARNP9321730 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
1139 | AK | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 003650500 | 05 |
| Street Address |
803 W ARLINGTON ST |
| City | BANGOR |
| State | MI |
| Zip Code | 49013-1108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871533166 | Angela Reed | Nurse Practitioner | 803 W Arlington St, Bangor Health Center, Bangor, MI 49013-1108 | 2006-06-07 |
| 1235300294 | Rebekah Lee Fatzinger | Psychologist | 803 W Arlington St, Bangor, MI 49013-1108 | 2008-03-18 |
| 1750438214 | Holly Husted | Nurse Practitioner | 803 W Arlington St, Bangor, MI 49013-1108 | 2007-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083237051 | Twin Doves I LLC | Community Based Residential Treatment Facility, Mental Illness | 48617 36th Ave., Bangor, MI 49013 | 2020-05-25 |
| 1629252895 | Van Buren Cass District Health Department | Community/Behavioral Health | 803 West Arlington, Bangor Health Center, Bangor, MI 49013 | 2007-12-24 |
| 1245426808 | Karen Lee Replogle | Registered Nurse | 52101 34th Avenue, Bangor, MI 49013 | 2007-09-18 |
| 1518152560 | Virginia Douglas | Registered Nurse | 52101 34 Avenue, Bangor, MI 49013 | 2007-09-12 |
| 1992818835 | Intercare Community Health Network | Clinic/Center | 308 Charles St, Bangor, MI 49013 | 2006-08-16 |
| 1326058512 | Intercare Community Health Network | Clinic/Center | 50 Industrial Park Dr, Bangor, MI 49013 | 2006-08-09 |
| 1962439950 | Michele E Allen | Dentist | 308 Charles Street, Bangor, MI 49013 | 2006-06-27 |
| 1366051898 | Kasie M Broe | Social Worker | 52101 34th Avenue, Bangor, MI 49013 | 2020-07-30 |
| 1255985966 | Audria Gilliland | Registered Nurse | 52101 34th Avenue, Bangor, MI 49013 | 2019-07-31 |
| 1417319476 | Terri Lynn Harbin Ilg | Dental Hygienist | 308 Charles Street, Intercare Community Health Network, Bangor, MI 49013 | 2016-03-28 |
| Find all providers in zip 49013 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073139465 | Jaclyn Kimberly Foraker | Nurse Practitioner | 885 Union St Ste 215, Bangor, ME 04401-3092 | 2020-06-22 |
| 1790326585 | Remigiusz Mariusz Paluszak | Nurse Practitioner | 417 State St #400, Bangor, Me 04401, Bangor, MA 04401-0440 | 2019-10-02 |
| 1629594882 | Auteum Lake | Nurse Practitioner | 277 State St Ste 1b, Bangor, ME 04401-5440 | 2017-08-19 |
| 1659730323 | Cherie Christopherson | Nurse Practitioner | 417 State St Ste 200, Bangor, ME 04401-6630 | 2016-02-23 |
| 1194060236 | Lori M. Lipari | Nurse Practitioner | 50521 34th Ave, Bangor, MI 49013-9726 | 2012-11-30 |
| 1306107446 | Theresa Marie Knowles | Nurse Practitioner | 103 Maine Ave, Bangor, ME 04401-4330 | 2012-06-05 |
| 1164594057 | Amy Cotton | Nurse Practitioner | 885 Union Street, Suite 221, Bangor, ME 04402-0404 | 2006-11-15 |
| 1003901729 | Nancy J Fishwick | Nurse Practitioner | 30 Mckinley St, Bangor, ME 04401-3830 | 2006-10-04 |
| 1528098316 | Constance M Springer-tracy | Nurse Practitioner | 656 State Street, Bangor, ME 04401-5609 | 2006-07-04 |
| 1699715417 | Claire J Mooney | Nurse Practitioner | 915 Union St, Bangor, ME 04401-8602 | 2006-06-08 |
| Find all providers in BANGOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.