Provider Demographics
NPI:1851538300
Name:KIERNAN, KRISTI DEGENSTEIN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:DEGENSTEIN
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18101 OAKWOOD BLVD
Mailing Address - Street 2:ANESTHESIOLOGY
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4089
Mailing Address - Country:US
Mailing Address - Phone:313-436-2374
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BOULEVARD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-436-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704228208367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered