Provider Demographics
NPI:1083735781
Name:ANGEVINE, KRISTI HAWKEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:HAWKEN
Last Name:ANGEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ANNE
Other - Last Name:HAWKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2400 NE NEFF RD STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6752
Mailing Address - Country:US
Mailing Address - Phone:541-389-3300
Mailing Address - Fax:541-389-8115
Practice Address - Street 1:2400 NE NEFF RD STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6752
Practice Address - Country:US
Practice Address - Phone:541-389-3300
Practice Address - Fax:541-389-8115
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44387207V00000X
ORMD176834207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology