Provider Demographics
NPI:1467965970
Name:TODD, KRYSTEN MARIE (GRNA)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:MARIE
Last Name:TODD
Suffix:
Gender:F
Credentials:GRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WILD PASTURE RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 WILD PASTURE RD
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:NH
Practice Address - Zip Code:03833-6712
Practice Address - Country:US
Practice Address - Phone:603-770-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10.087972367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered