Provider Demographics
NPI:1619135076
Name:EARLY, KRISTAL
Entity Type:Individual
Prefix:MS
First Name:KRISTAL
Middle Name:
Last Name:EARLY
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 1:35456 EDGETON CT APT 108
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2443
Mailing Address - Country:US
Mailing Address - Phone:877-775-3503
Mailing Address - Fax:
Practice Address - Street 1:35456 EDGETON CT APT 108
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2443
Practice Address - Country:US
Practice Address - Phone:877-775-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver