Provider Demographics
NPI:1710067707
Name:IDLE, CHRISTY A (RN, MSN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:A
Last Name:IDLE
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:A
Other - Last Name:DUFFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3810
Mailing Address - Fax:517-913-3811
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3810
Practice Address - Fax:517-913-3811
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214994363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1046484OtherMCLAREN HEALTH ADVANTAGE
MI1046484OtherMCLAREN HEALTH PLAN-MEDICAID
MI1046484OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI5008707670OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI5195263Medicaid
MIP00473887OtherRAILROAD MEDICARE
MI0N55170015OtherMEDICARE PLUS BLUE
MI9741241OtherAETNA
MI114837094Medicaid
MI9741241OtherAETNA
MIQ40074Medicare UPIN
MIN55170015Medicare PIN