Provider Demographics
NPI:1811727548
Name:PETOSKEY, CHRISTOPHER LEE (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:PETOSKEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20095 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2365
Mailing Address - Country:US
Mailing Address - Phone:231-592-1360
Mailing Address - Fax:231-592-1361
Practice Address - Street 1:20095 GILBERT RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2365
Practice Address - Country:US
Practice Address - Phone:231-592-1360
Practice Address - Fax:231-592-1361
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704420004363L00000X, 363LF0000X
PASP030312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily