Provider Demographics
NPI:1083998041
Name:ETRI, KRYSTLE CONNIE (ND)
Entity Type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:CONNIE
Last Name:ETRI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 E PLAYA DEL NORTE DR
Mailing Address - Street 2:APT 1405
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2176
Mailing Address - Country:US
Mailing Address - Phone:516-695-7665
Mailing Address - Fax:
Practice Address - Street 1:1001 E PLAYA DEL NORTE DR
Practice Address - Street 2:APT 1405
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2176
Practice Address - Country:US
Practice Address - Phone:516-695-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11-1264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine