Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704157442 | MI |
N | 363LC1500X | Nurse Practitioner - Community Health | 4704157442 | MI |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704157442 | MI |
NPI | 1225030497 |
---|---|
Provider Name | Ms. Kristi Vander Hyde |
First Address | Ann Arbor, MI 48108 |
Second Address | Dexter, MI 48130-8598 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 31/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0860085 | BCBS OF MICHIGAN (01) | MI |
104702549 | (05) | MI |
4851610 | (05) | MI |
P67573 | (02) | MI |