Healthcare Provider Details

I. General information

NPI: 1659670610
Provider Name (Legal Business Name): KRISTEN RAE KERBLESKI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4177 FASHION SQUARE BLVD SUITE 1
SAGINAW MI
48603-5216
US

IV. Provider business mailing address

4177 FASHION SQUARE BLVD SUITE 1
SAGINAW MI
48603-5216
US

V. Phone/Fax

Practice location:
  • Phone: 989-791-9100
  • Fax: 989-791-6746
Mailing address:
  • Phone: 989-791-9100
  • Fax: 989-791-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704246844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: