Provider Demographics
NPI:1194387589
Name:CANFIELD, KRIS ANN (LPN)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:ANN
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 EISENHOWER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3262
Mailing Address - Country:US
Mailing Address - Phone:814-269-1494
Mailing Address - Fax:814-266-8572
Practice Address - Street 1:2001 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1096
Practice Address - Country:US
Practice Address - Phone:814-241-0047
Practice Address - Fax:814-266-8572
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN088340L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse