Provider Demographics
NPI:1508532284
Name:KRUMM, LINDA JEAN (RN, BSN, CCM)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JEAN
Last Name:KRUMM
Suffix:
Gender:F
Credentials:RN, BSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0443
Mailing Address - Country:US
Mailing Address - Phone:810-772-9576
Mailing Address - Fax:810-231-1536
Practice Address - Street 1:6793 ALTA DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6220
Practice Address - Country:US
Practice Address - Phone:810-772-9576
Practice Address - Fax:810-231-1536
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704140412163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI04051960Medicaid
MI04051969Medicaid