Provider Demographics
NPI:1730760208
Name:STREET, ANNETTE (RN)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:KALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:641 W SCHLEIER ST APT B7
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1081
Mailing Address - Country:US
Mailing Address - Phone:210-501-2757
Mailing Address - Fax:
Practice Address - Street 1:641 W SCHLEIER ST APT B7
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1081
Practice Address - Country:US
Practice Address - Phone:210-501-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX732789163W00000X
MI4704317866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse