Provider Demographics
NPI:1336794841
Name:SHOOK, KRISTEN JANKOWSKI (CPM, LM)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JANKOWSKI
Last Name:SHOOK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 W TENTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3136
Mailing Address - Country:US
Mailing Address - Phone:231-944-9328
Mailing Address - Fax:231-346-6087
Practice Address - Street 1:543 W TENTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3136
Practice Address - Country:US
Practice Address - Phone:231-944-9328
Practice Address - Fax:231-346-6087
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000042176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife