Provider Demographics
NPI:1275857351
Name:SIEGRIST, KRISTINA (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SIEGRIST
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:BLDG. 301 ANDREWS AVENUE
Mailing Address - Street 2:LYSTER ARMY HEALTH CLNIC
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7755
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 301 ANDREWS AVENUE
Practice Address - Street 2:LYSTER ARMY HEALTH CLNIC
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-046276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse