Healthcare Provider Details

I. General information

NPI: 1508532284
Provider Name (Legal Business Name): LINDA JEAN KRUMM RN, BSN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6793 ALTA DR
BRIGHTON MI
48116-6220
US

IV. Provider business mailing address

PO BOX 443
HAMBURG MI
48139-0443
US

V. Phone/Fax

Practice location:
  • Phone: 810-772-9576
  • Fax: 810-231-1536
Mailing address:
  • Phone: 810-772-9576
  • Fax: 810-231-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704140412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: