Provider Demographics
NPI:1164022331
Name:SHRIFT, ANNA LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:LYNN
Last Name:SHRIFT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 BLACK HILL LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8674
Mailing Address - Country:US
Mailing Address - Phone:231-632-1951
Mailing Address - Fax:
Practice Address - Street 1:849 BLACK HILL LN
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8674
Practice Address - Country:US
Practice Address - Phone:231-632-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1170887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant