Provider Demographics
NPI:1477317782
Name:VIGNEAU, KERI JEAN
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:JEAN
Last Name:VIGNEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 M 119
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740
Mailing Address - Country:US
Mailing Address - Phone:231-347-4979
Mailing Address - Fax:231-347-2861
Practice Address - Street 1:3434 M 119
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740
Practice Address - Country:US
Practice Address - Phone:231-347-4979
Practice Address - Fax:231-347-2861
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1234172V00000X
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker