Healthcare Provider Details

I. General information

NPI: 1346010956
Provider Name (Legal Business Name): KRISTEN MARIE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W GENESEE ST STE 4
FRANKENMUTH MI
48734-1357
US

IV. Provider business mailing address

7374 LAWRENCE ST
GRAND BLANC MI
48439-9341
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-2577
  • Fax: 989-652-4776
Mailing address:
  • Phone: 989-522-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501009303
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: