Provider Demographics
NPI:1467168369
Name:PEDRAJAS, KRISTINE NAE UY (BSN)
Entity Type:Individual
Prefix:
First Name:KRISTINE NAE
Middle Name:UY
Last Name:PEDRAJAS
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27084
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-6943
Mailing Address - Country:US
Mailing Address - Phone:671-777-2587
Mailing Address - Fax:
Practice Address - Street 1:125 CHOTDA COURT, LIGUAN TERRACE
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96921
Practice Address - Country:US
Practice Address - Phone:671-777-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURE1384163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU1228087402OtherGUAM DRIVERS LICENSE