Provider Demographics
NPI:1538450226
Name:KIRSCH, CELINA ANN (PA)
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:ANN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3890
Mailing Address - Fax:517-913-3891
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3890
Practice Address - Fax:517-913-3891
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2021-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1153304150OtherBLUE CROSS BLUE SHIELD
MI1153304150OtherBLUE CROSS BLUE SHIELD