1982082632 NPI number — MRS. KRISTIN MICHELLE RHAN LPN

Table of content: MRS. KRISTIN MICHELLE RHAN LPN (NPI 1982082632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982082632 NPI number — MRS. KRISTIN MICHELLE RHAN LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHAN
Provider First Name:
KRISTIN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982082632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10195 DIANE ST APT 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROMULUS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48174-3322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-918-9978
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10195 DIANE ST. APT302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROMULUS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-918-9979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  4703115044 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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