Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 05-37324 | KS |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2101018124 | MI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5315040441 | MI |
NPI | 1215165071 |
---|---|
Provider Name | Dr. Kristina M Manion |
First Address | Holland, MI 49424 |
Second Address | Holland, MI 49424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 14/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200557810A | (05) | OK |
201098280A | (05) | KS |