Healthcare Provider Details

I. General information

NPI: 1265873335
Provider Name (Legal Business Name): KRISTIN MARIE JOHNSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN MARIE SCHNEIDER P.A.

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5694 MIDLAND RD
FREELAND MI
48623-8845
US

IV. Provider business mailing address

5694 MIDLAND RD
FREELAND MI
48623-8845
US

V. Phone/Fax

Practice location:
  • Phone: 989-695-2123
  • Fax: 989-695-2316
Mailing address:
  • Phone: 989-695-2123
  • Fax: 989-695-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: