Provider Demographics
NPI:1689936635
Name:CRANDALL, CHRISTINA MARIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIA
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MARIA
Other - Last Name:KOEHLMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:30550 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1528
Mailing Address - Country:US
Mailing Address - Phone:586-771-0290
Mailing Address - Fax:586-771-5450
Practice Address - Street 1:30550 UTICA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1528
Practice Address - Country:US
Practice Address - Phone:586-771-0290
Practice Address - Fax:586-771-5450
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704181166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse