MEDICARE: KIMBERLEY JOHNSON-CRISANTI CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	4704188421	MI

General Provider Information

NPI Number	:	1649416207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY JOHNSON-CRISANTI CNM

Provider Business Mailing Address
First Line	:	1100 E MICHIGAN AVE
Second Line	:	SUIE 202
City	:	JACKSON
State	:	MI
Zip	:	49201-1847
Country	:	US
Telephone Number	:	517-787-6210
Fax Number	:	517-784-6144

Provider Business Practice Location Address
First Line	:	1100 E MICHIGAN AVE STE 202
Second Line	:	205 NORTH EAST AVE.
City	:	JACKSON
State	:	MI
Zip	:	49201-1800
Country	:	US
Telephone Number	:	517-788-4800
Fax Number	:	517-841-6917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2008
Last Update Date	:	08/21/2013

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Directions to “ KIMBERLEY JOHNSON-CRISANTI CNM” Practice Location

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