Provider Demographics
NPI:1558494393
Name:WOODS, KRISTINA MARIE (PHD, RN, CLNC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MARIE
Last Name:WOODS
Suffix:
Gender:F
Credentials:PHD, RN, CLNC
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:932 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4906
Mailing Address - Country:US
Mailing Address - Phone:909-798-3775
Mailing Address - Fax:
Practice Address - Street 1:31156 CHESAPEAKE LN
Practice Address - Street 2:
Practice Address - City:MENTONE
Practice Address - State:CA
Practice Address - Zip Code:92359-1536
Practice Address - Country:US
Practice Address - Phone:909-798-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN269545174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator