Provider Demographics
NPI:1225587322
Name:MEINES, KRISTYN JOY (CTRS)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:JOY
Last Name:MEINES
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 PIUTE CT SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2429
Mailing Address - Country:US
Mailing Address - Phone:616-457-3633
Mailing Address - Fax:
Practice Address - Street 1:3349 PIUTE CT SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2429
Practice Address - Country:US
Practice Address - Phone:616-457-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM520478447597247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other