Provider Demographics
NPI:1356591135
Name:RIBITCH, KRISTINE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:RIBITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:MARIE
Other - Last Name:MUXLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2853 HEALTH PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-7641
Mailing Address - Fax:989-775-6472
Practice Address - Street 1:2853 HEALTH PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3872
Practice Address - Country:US
Practice Address - Phone:989-775-7641
Practice Address - Fax:989-775-6472
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant