Provider Demographics
NPI:1255479622
Name:SABANOSH, KRISTIN MICHELLE (RN MSN CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:SABANOSH
Suffix:
Gender:F
Credentials:RN MSN CPNP
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:MICHELLE
Other - Last Name:BYRNE-SABANOSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN MSN CPNP
Mailing Address - Street 1:21 VALLEY VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1418
Mailing Address - Country:US
Mailing Address - Phone:617-319-1979
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-8942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381873363LP0200X
NJ26NJ00369000363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics