Provider Demographics
NPI:1285858928
Name:ANZULAVICH, KRISTIE MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:ANZULAVICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-1407
Mailing Address - Country:US
Mailing Address - Phone:570-538-4381
Mailing Address - Fax:570-538-4381
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9362
Practice Address - Country:US
Practice Address - Phone:570-522-4279
Practice Address - Fax:570-522-2193
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009132363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health