Provider Demographics
NPI:1326913203
Name:REDERSTORF, MISTY DAWN
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:REDERSTORF
Suffix:
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 1:5070 DUCK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-9723
Mailing Address - Country:US
Mailing Address - Phone:317-417-5508
Mailing Address - Fax:
Practice Address - Street 1:5070 DUCK LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-9723
Practice Address - Country:US
Practice Address - Phone:317-417-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704376194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse