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Individual

KIRSTEN M SHIVELY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1550 3 MILE RD NW, WALKER, MI 49544-8251
(616) 785-3883
(616) 785-1982
Mailing address
1550 3 MILE ROAD NW, WALKER, MI 49544
(616) 785-3883
(616) 785-1982

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003678
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0M80080
MEDICARE
MI
01
1598712390
GROUP NPI
MI
01
1649287517
GROUP NPI
MI
Enumeration date
09/06/2006
Last updated
02/17/2021
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