Provider Demographics
NPI:1538637749
Name:DEPPEN, KRISTIN NEDERVELD
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NEDERVELD
Last Name:DEPPEN
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 1:3933 WINSOME WAY
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8216
Mailing Address - Country:US
Mailing Address - Phone:616-915-2734
Mailing Address - Fax:
Practice Address - Street 1:13575 S AIRPORT RD STE 105
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-9101
Practice Address - Country:US
Practice Address - Phone:517-668-6676
Practice Address - Fax:517-668-0017
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist