Provider Demographics
NPI:1275513616
Name:MIKEL, KIRSTIN L (CRNA)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:L
Last Name:MIKEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 LAKEBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4184
Mailing Address - Country:US
Mailing Address - Phone:231-590-4921
Mailing Address - Fax:
Practice Address - Street 1:1447 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:231-935-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKM220975367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430B810310OtherBCBS TSC
MIP00270473OtherMEDICARE RR TSC
MI46901017Medicaid
MIP00270473OtherMEDICARE RR TSC
MI46901017Medicaid
MI430B810310OtherBCBS TSC