Provider Demographics
NPI:1609856228
Name:DONEWALD, KRISTIN A (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:DONEWALD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE N1200
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7979
Mailing Address - Fax:269-341-6261
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE N1200
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7979
Practice Address - Fax:269-341-6261
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704194038367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4786656Medicaid
MIM74680016Medicare PIN