Healthcare Provider Details

I. General information

NPI: 1578156832
Provider Name (Legal Business Name): KRYSTA MARIE MENEER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTA MARIE NOLL

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WEXFORD AVE
MIDLAND MI
48640-5681
US

IV. Provider business mailing address

400 WEXFORD AVE
MIDLAND MI
48640-5681
US

V. Phone/Fax

Practice location:
  • Phone: 989-506-9836
  • Fax:
Mailing address:
  • Phone: 989-506-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: