Provider Demographics
NPI:1003962929
Name:COLLETTI, KRISTA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:L
Last Name:COLLETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JONES ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5512
Mailing Address - Country:US
Mailing Address - Phone:775-322-1880
Mailing Address - Fax:775-322-1897
Practice Address - Street 1:1001 JONES ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5512
Practice Address - Country:US
Practice Address - Phone:775-322-1880
Practice Address - Fax:775-322-1897
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist