Individual
KRISTI ILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
522 S MAPLE RD, ANN ARBOR, MI 48103-3837
(734) 585-7970
Mailing address
522 S MAPLE RD, ANN ARBOR, MI 48103-3837
(734) 585-7970
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
4704252014
MI
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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