Provider Demographics
NPI:1659670610
Name:KERBLESKI, KRISTEN RAE (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RAE
Last Name:KERBLESKI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4177 FASHION SQUARE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-5216
Mailing Address - Country:US
Mailing Address - Phone:989-791-9100
Mailing Address - Fax:989-791-6746
Practice Address - Street 1:4177 FASHION SQUARE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-5216
Practice Address - Country:US
Practice Address - Phone:989-791-9100
Practice Address - Fax:989-791-6746
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily