Provider Demographics
NPI:1023284981
Name:LAIRD, CRISTEN LYN (DO)
Entity type:Individual
Prefix:DR
First Name:CRISTEN
Middle Name:LYN
Last Name:LAIRD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CRISTEN
Other - Middle Name:LYN
Other - Last Name:DAHL-FULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1405 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3335
Mailing Address - Country:US
Mailing Address - Phone:734-307-3040
Mailing Address - Fax:
Practice Address - Street 1:2128 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-5470
Practice Address - Country:US
Practice Address - Phone:734-307-3040
Practice Address - Fax:734-818-5714
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017734208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery