Provider Demographics
NPI:1417284878
Name:SCALZITTI, KRISTINA LAUREN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LAUREN
Last Name:SCALZITTI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3915
Mailing Address - Country:US
Mailing Address - Phone:219-313-2020
Mailing Address - Fax:
Practice Address - Street 1:901 LINCOLNWAY STE 212
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3429
Practice Address - Country:US
Practice Address - Phone:708-960-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160519A363LF0000X
IN71003111A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN363257151OtherTIN NUMBER