Individual
KRISTEN WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-8040
Mailing address
19746 FAIRBROOK DR, MACOMB, MI 48044-2840
(586) 549-7356
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704312224
MI
163W00000X
Registered Nurse
475580
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.0020732
OH
Other
Enumeration date
12/08/2022
Last updated
01/02/2024
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