Healthcare Provider Details

I. General information

NPI: 1710067707
Provider Name (Legal Business Name): CHRISTY A IDLE RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY A DUFFIELD

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD SUITE 102
LANSING MI
48912-3756
US

IV. Provider business mailing address

1540 LAKE LANSING RD SUITE 102
LANSING MI
48912-3756
US

V. Phone/Fax

Practice location:
  • Phone: 517-913-3810
  • Fax: 517-913-3811
Mailing address:
  • Phone: 517-913-3810
  • Fax: 517-913-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704214994
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: