Provider Demographics
NPI:1467827360
Name:AMUNDSON, KRISTINA (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:SELKIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1626 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7466
Mailing Address - Country:US
Mailing Address - Phone:907-479-7701
Mailing Address - Fax:907-479-7718
Practice Address - Street 1:1626 30TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7466
Practice Address - Country:US
Practice Address - Phone:907-479-7701
Practice Address - Fax:907-479-7718
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR30853163W00000X
AK106394363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse