Provider Demographics
NPI:1376922385
Name:VALENCIC, KRISTIANNA
Entity Type:Individual
Prefix:
First Name:KRISTIANNA
Middle Name:
Last Name:VALENCIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 E WATERFRONT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1151
Mailing Address - Country:US
Mailing Address - Phone:412-678-0534
Mailing Address - Fax:412-678-2838
Practice Address - Street 1:495 E WATERFRONT DR STE 200
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1151
Practice Address - Country:US
Practice Address - Phone:412-678-0534
Practice Address - Fax:412-678-2838
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1886363A00000X
PAMA057513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1R2542OtherMEDICARE