Provider Demographics
NPI:1457333098
Name:BUCHHOLZ, KRISTIE SUE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:SUE
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4829 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9747
Practice Address - Country:US
Practice Address - Phone:616-363-9069
Practice Address - Fax:616-363-0724
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704118571363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460335Medicare PIN
MI0M74460335Medicare PIN