Provider Demographics
NPI:1649416207
Name:JOHNSON-CRISANTI, KIMBERLEY (CNM)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:JOHNSON-CRISANTI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:SUIE 202
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1847
Mailing Address - Country:US
Mailing Address - Phone:517-787-6210
Mailing Address - Fax:517-784-6144
Practice Address - Street 1:1100 E MICHIGAN AVE STE 202
Practice Address - Street 2:205 NORTH EAST AVE.
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1800
Practice Address - Country:US
Practice Address - Phone:517-788-4800
Practice Address - Fax:517-841-6917
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704188421367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife