Healthcare Provider Details

I. General information

NPI: 1952953390
Provider Name (Legal Business Name): KRISTIN MARIE MEES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W GANSON ST
JACKSON MI
49201-1047
US

IV. Provider business mailing address

913 S DURAND ST
JACKSON MI
49203-2842
US

V. Phone/Fax

Practice location:
  • Phone: 517-250-6060
  • Fax:
Mailing address:
  • Phone: 517-250-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703095495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: