Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 02004656A | IN |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 5101017875 | MI |
N | 207RC0000X | Internist - Cardiovascular Disease | 02004656A | IN |
NPI | 1730343583 |
---|---|
Provider Name | Kristen N. Maurice |
First Address | Traverse City, MI 49684-2369 |
Second Address | Traverse City, MI 49684-2369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201307880 | (05) | IN |