Provider Demographics
NPI:1518219971
Name:GUALTIERI, KRYSTINA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:KRYSTINA
Middle Name:MARIE
Last Name:GUALTIERI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 DORIS ST
Mailing Address - Street 2:PO BOX 41
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466-7787
Mailing Address - Country:US
Mailing Address - Phone:845-338-5202
Mailing Address - Fax:
Practice Address - Street 1:211 DORIS ST
Practice Address - Street 2:
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466-7787
Practice Address - Country:US
Practice Address - Phone:845-338-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22650188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse