Basic Information
| Provider Information | |||||||||
| NPI: | 1356591135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIBITCH | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.A.-C. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MUXLOW | ||||||||
| OtherFirstName: | KRISTINE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2853 HEALTH PARKWAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897757641 | ||||||||
| FaxNumber: | 9897756472 | ||||||||
| Practice Location | |||||||||
| Address1: | 2853 HEALTH PARKWAY | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488583872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897757641 | ||||||||
| FaxNumber: | 9897756472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601005381 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.