# KRISTAN M OUTWATER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1306952890
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 042-0012623 | VT | Yes |
| 2080P0203X | Pediatric Critical Care Medicine Physician | 4301064412 | MI | — |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 06/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3067291 | — | MI |
| 01 | — | 71020000730099 | BCBS OF MI | MI |