Healthcare Provider Details

I. General information

NPI: 1023529427
Provider Name (Legal Business Name): KRISTINE NICOLE TOMLINSON-MILES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINE CRAWFORD

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W LAKE LANSING RD STE 200
EAST LANSING MI
48823-6322
US

IV. Provider business mailing address

912 STUART AVE
EAST LANSING MI
48823-3144
US

V. Phone/Fax

Practice location:
  • Phone: 517-706-2447
  • Fax: 517-201-1659
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number4704302422
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704302422
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: