Provider Demographics
NPI:1225602121
Name:ELIZABETH, KRISTIN (RN)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:ELIZABETH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 MILL BAY RD APT B105
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6435
Mailing Address - Country:US
Mailing Address - Phone:907-654-9257
Mailing Address - Fax:
Practice Address - Street 1:1223 MILL BAY RD APT B105
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6435
Practice Address - Country:US
Practice Address - Phone:907-654-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK160391163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty