Provider Demographics
NPI:1770791246
Name:KHOL, ANNE CAMERON (ND, FNP, BC)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:CAMERON
Last Name:KHOL
Suffix:
Gender:F
Credentials:ND, FNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11651 S US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9730
Mailing Address - Country:US
Mailing Address - Phone:517-669-1164
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1952
Practice Address - Country:US
Practice Address - Phone:517-999-4500
Practice Address - Fax:517-999-4510
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156986363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner