Provider Demographics
NPI:1528400736
Name:DELLEDONNE, KRISTIN SARA
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:SARA
Last Name:DELLEDONNE
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 1:1001 UPPER REACH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2662
Mailing Address - Country:US
Mailing Address - Phone:907-602-5856
Mailing Address - Fax:
Practice Address - Street 1:1001 UPPER REACH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2662
Practice Address - Country:US
Practice Address - Phone:907-602-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5686367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered