Individual
MS. KRISTI VANDER HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7300 DEXTER-ANN ARBOR RD, DEXTER, MI 48130-8598
(734) 426-2796
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704157442
MI
363LC1500X
Community Health Nurse Practitioner
4704157442
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704157442
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0860085
BCBS OF MICHIGAN
MI
05
—
104702549
—
MI
05
—
4851610
—
MI
Enumeration date
06/01/2005
Last updated
12/31/2015
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