Provider Demographics
NPI:1164196721
Name:SKUDRNA, KRISTI A
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:A
Last Name:SKUDRNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-3930
Mailing Address - Country:US
Mailing Address - Phone:630-947-2713
Mailing Address - Fax:
Practice Address - Street 1:1075 BIRCH LN
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-3930
Practice Address - Country:US
Practice Address - Phone:630-947-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information