| Doctor Name: | KRISTA DELONG |
| NPI Number: | 1144260266 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 5601003308 |
| Business Practice Address: | 1445 Sheldon Rd Ste 302 Grand Haven, MI - 494172479 |
| Business Phone Number: | 6168423250 |
| Business Fax Number: | 6168420754 |
| Mailing Address: | 100 Michigan St Ne # Mc845, GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495032560 |
| Phone Number: | 6164866790 |
| Fax Number: | 6164866702 |
| NPI Enumeration Date: | 06/07/2006 |
| NPI Last Update Date: | 07/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601003308 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |