Provider Demographics
NPI:1194381046
Name:SMORTO-KASPER, KRISTINA CARMELA (RN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:CARMELA
Last Name:SMORTO-KASPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:CAREMELA
Other - Last Name:KASPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:351 PROSPECT AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5532
Mailing Address - Country:US
Mailing Address - Phone:917-940-9184
Mailing Address - Fax:
Practice Address - Street 1:351 PROSPECT AVE APT 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5532
Practice Address - Country:US
Practice Address - Phone:917-940-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY553451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse