Healthcare Provider Details

I. General information

NPI: 1225083637
Provider Name (Legal Business Name): KRISTIN A LANCE CFNP, RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W CEDAR ST
STANDISH MI
48658-9526
US

IV. Provider business mailing address

3061 CHRISTY WAY
SAGINAW MI
48603-2267
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-3545
  • Fax: 989-846-3557
Mailing address:
  • Phone: 989-791-2455
  • Fax: 989-791-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704195579
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: