Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5101013029 | MI |
NPI | 1093869992 |
---|---|
Provider Name | Dr. Michelle Sue Cranick-Kuster |
First Address | Fountain Valley, CA 92728-8309 |
Second Address | Ludington, MI 49431-1906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G81829 | (02) | MI |