Basic Information
| Provider Information | |||||||||
| NPI: | 1770791246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOL | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | CAMERON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | N.D., F.N.P., B.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11651 S US HIGHWAY 27 | ||||||||
| Address2: | |||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488209730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176691164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EATON RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488271952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179994500 | ||||||||
| FaxNumber: | 5179994510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704156986 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.