Provider Demographics
NPI:1255167516
Name:RAYMER, KRISTINA LYNN I
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:RAYMER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7197 N TRUESDALE RD
Mailing Address - Street 2:
Mailing Address - City:MANTON
Mailing Address - State:MI
Mailing Address - Zip Code:49663-9024
Mailing Address - Country:US
Mailing Address - Phone:231-633-6059
Mailing Address - Fax:
Practice Address - Street 1:7197 N TRUESDALE RD
Practice Address - Street 2:
Practice Address - City:MANTON
Practice Address - State:MI
Practice Address - Zip Code:49663-9024
Practice Address - Country:US
Practice Address - Phone:231-633-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker