Provider Demographics
NPI:1346425667
Name:OBENAUER, KRISTI L (CSA)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:OBENAUER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 MINNESOTA CIR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9217
Mailing Address - Country:US
Mailing Address - Phone:630-546-3816
Mailing Address - Fax:
Practice Address - Street 1:457 MINNESOTA CIR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9217
Practice Address - Country:US
Practice Address - Phone:630-546-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant