Healthcare Provider Details

I. General information

NPI: 1639068448
Provider Name (Legal Business Name): KRISTIN MARIE DUBAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E PECK RD
PECK MI
48466-9589
US

IV. Provider business mailing address

6845 RAYMANN CT
KIMBALL MI
48074-2317
US

V. Phone/Fax

Practice location:
  • Phone: 810-378-4900
  • Fax:
Mailing address:
  • Phone: 586-764-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704343115
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: