Provider Demographics
NPI:1790978351
Name:AHLSTROM, KRISTIN M (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:AHLSTROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3320
Mailing Address - Country:US
Mailing Address - Phone:906-228-9789
Mailing Address - Fax:
Practice Address - Street 1:722 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3720
Practice Address - Country:US
Practice Address - Phone:906-226-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704179837163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse