Provider Demographics
NPI:1700313921
Name:AHRENS, KRISTIN BENIT (NP)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:BENIT
Last Name:AHRENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 FLAMINGO
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-1508
Mailing Address - Country:US
Mailing Address - Phone:248-921-1557
Mailing Address - Fax:
Practice Address - Street 1:1369 FLAMINGO
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-1508
Practice Address - Country:US
Practice Address - Phone:248-921-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704223000363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics