Provider Demographics
NPI:1508321712
Name:URQUHART, KRISTINA MARIE
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MARIE
Last Name:URQUHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 MOONLITE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-2148
Mailing Address - Country:US
Mailing Address - Phone:805-714-6448
Mailing Address - Fax:
Practice Address - Street 1:961 MOONLITE DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-2148
Practice Address - Country:US
Practice Address - Phone:805-714-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286247164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty