Provider Demographics
NPI:1033648738
Name:DISORBO, KRYSTLE LEE (NP)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:LEE
Last Name:DISORBO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KRYSTLE
Other - Middle Name:
Other - Last Name:LEMIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3201 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6078
Mailing Address - Country:US
Mailing Address - Phone:603-380-9159
Mailing Address - Fax:
Practice Address - Street 1:3201 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6078
Practice Address - Country:US
Practice Address - Phone:603-380-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2279609363LA2200X
NH066034-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health