Provider Demographics
NPI:1477984953
Name:FAIR, KRISTINA VICTOR (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:VICTOR
Last Name:FAIR
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 VANTAGE CT
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3452
Mailing Address - Country:US
Mailing Address - Phone:973-343-7340
Mailing Address - Fax:
Practice Address - Street 1:1600 SAINT GEORGES AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2764
Practice Address - Country:US
Practice Address - Phone:732-499-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00494500363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care