Healthcare Provider Details

I. General information

NPI: 1891133559
Provider Name (Legal Business Name): KRISTEN TWEEDY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1000
  • Fax: 906-483-1270
Mailing address:
  • Phone: 906-483-1000
  • Fax: 906-483-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number13627
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA14585
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704336005
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: