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General NPI Number Information
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NPI Number | 1710067707
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Entity Type | Individual
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Provider Name | CHRISTY A IDLE RN, MSN
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 1540 LAKE LANSING RD SUITE 102
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City | LANSING
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State | MI
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Zip | 48912-3756
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Country | US
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Telephone | 517-913-3810
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Fax | 517-913-3811
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Provider Business Mailing Address
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Address Line | 1540 LAKE LANSING RD SUITE 102
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City | LANSING
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State | MI
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Zip | 48912-3756
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Country | US
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Telephone | 517-913-3810
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Fax | 517-913-3811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704214994
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License Number State | MI
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