Provider Demographics
NPI:1003122649
Name:GAUCK, KRISTIE LEE (CRNP-F)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:LEE
Last Name:GAUCK
Suffix:
Gender:F
Credentials:CRNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 CLOVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:HURLOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21643-3025
Mailing Address - Country:US
Mailing Address - Phone:410-943-3275
Mailing Address - Fax:
Practice Address - Street 1:5745 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:HURLOCK
Practice Address - State:MD
Practice Address - Zip Code:21643-3025
Practice Address - Country:US
Practice Address - Phone:410-943-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily