Individual
KRYSTAL GOUDREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
113 N LAKE ST, MANISTIQUE, MI 49854-1234
(906) 450-1700
Mailing address
113 N LAKE ST, MANISTIQUE, MI 49854-1234
(906) 450-1700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704260602
MI
363LF0000X
Family Nurse Practitioner
Primary
4704260602
MI
Other
Enumeration date
04/25/2017
Last updated
08/09/2023
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