Provider Demographics
NPI:1083025233
Name:MATHELIER, KRYSTINA THERESE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:THERESE
Last Name:MATHELIER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SIDNEY DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-4532
Mailing Address - Country:US
Mailing Address - Phone:845-425-9647
Mailing Address - Fax:
Practice Address - Street 1:3411 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2509
Practice Address - Country:US
Practice Address - Phone:718-920-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306721363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health