Healthcare Provider Details

I. General information

NPI: 1497372882
Provider Name (Legal Business Name): KRISTIN MARIE MCLAVY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN MARIE CRACKEL RN

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S CHAPMAN ST
CHESANING MI
48616-1304
US

IV. Provider business mailing address

PO BOX 4414
FLINT MI
48504-0414
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4704260471
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704260471
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: