Provider Demographics
NPI:1619690393
Name:THRONE, KRYSTAL RENEE' (CLC, CMA)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:RENEE'
Last Name:THRONE
Suffix:
Gender:F
Credentials:CLC, CMA
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:WARDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMA
Mailing Address - Street 1:2670 S LAKE PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2670 S LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-9372
Practice Address - Country:US
Practice Address - Phone:248-396-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty