Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704212854 | MI |
NPI | 1043887672 |
---|---|
Provider Name | Kristi Kostoff |
First Address | Newport, MI 48166-9040 |
Second Address | Riverview, MI 48193-7909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 10/06/2021 |