Individual
KRISTEN E DETWEILER SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 E MEDICAL CENTER DR, B1 FLOOR CANCER & GERIATRICS CENTER RECP B, ANN ARBOR, MI 48109-5911
(734) 936-6000
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
Primary
4704283503
MI
363L00000X
Nurse Practitioner
R 160910-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00646034
RAILROAD MEDICARE
MN
Enumeration date
08/15/2008
Last updated
06/03/2011
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