Provider Demographics
NPI:1003162181
Name:KRISTELLER, DIANNA ELKENBAUM (CNM, DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:ELKENBAUM
Last Name:KRISTELLER
Suffix:
Gender:F
Credentials:CNM, DNP, APRN
Other - Prefix:MRS
Other - First Name:DIANNA
Other - Middle Name:ELKENBAUM
Other - Last Name:KRISTELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, DNP, APRN
Mailing Address - Street 1:PO BOX 1275
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-1275
Mailing Address - Country:US
Mailing Address - Phone:907-545-8847
Mailing Address - Fax:
Practice Address - Street 1:700 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1319363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology