Healthcare Provider Details

I. General information

NPI: 1659053742
Provider Name (Legal Business Name): KRISTY BOVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 LUDINGTON ST STE H
ESCANABA MI
49829-3565
US

IV. Provider business mailing address

97 S 4TH ST
ISHPEMING MI
49849-2168
US

V. Phone/Fax

Practice location:
  • Phone: 906-789-3528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: