Provider Demographics
NPI:1548740426
Name:KOMAR, KRISTINA MARLENE (NP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARLENE
Last Name:KOMAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2628
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2628
Mailing Address - Country:US
Mailing Address - Phone:559-537-0170
Mailing Address - Fax:
Practice Address - Street 1:1025 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3722
Practice Address - Country:US
Practice Address - Phone:559-537-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily