Provider Demographics
NPI:1477840106
Name:STENLUND, KRISTIE LEE (NP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEE
Last Name:STENLUND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1390
Mailing Address - Country:US
Mailing Address - Phone:906-789-3198
Mailing Address - Fax:906-789-3679
Practice Address - Street 1:2530 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1390
Practice Address - Country:US
Practice Address - Phone:906-789-3198
Practice Address - Fax:906-789-3679
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219724163W00000X, 363L00000X
WI123429-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0871741OtherBCBSMI PIN
MIP38340034Medicare Oscar/Certification