Individual
MS. KYRA MONIQUE SHIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3205 SUPPLY RD, TRAVERSE CITY, MI 49696-9486
(231) 935-1070
Mailing address
3049 CRIMSON RANCH LN, TRAVERSE CITY, MI 49685-9767
(231) 239-2468
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704339826
MI
164W00000X
Licensed Practical Nurse
4703119005
MI
Other
Enumeration date
11/27/2017
Last updated
10/01/2018
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