Provider Demographics
NPI:1508137498
Name:WUOLLET, KRISTIINA E (RN BA MICRO)
Entity Type:Individual
Prefix:MS
First Name:KRISTIINA
Middle Name:E
Last Name:WUOLLET
Suffix:
Gender:F
Credentials:RN BA MICRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2133
Mailing Address - Country:US
Mailing Address - Phone:602-257-3900
Mailing Address - Fax:
Practice Address - Street 1:123 N 13TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1111
Practice Address - Country:US
Practice Address - Phone:602-257-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN161913163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse