Provider Demographics
NPI: | 1629376926 |
---|---|
Name: | WAMSHER, KRISTY CAROL (CRTT) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | KRISTY |
Middle Name: | CAROL |
Last Name: | WAMSHER |
Suffix: | |
Gender: | F |
Credentials: | CRTT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 17312 IPSWICH WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKEVILLE |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55044-9698 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-898-2147 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 201 E NICOLLET BLVD |
Practice Address - Street 2: | |
Practice Address - City: | BURNSVILLE |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55337-5714 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-892-2495 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-03-10 |
Last Update Date: | 2011-03-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 2193 | 227800000X |
2278C0205X, 2278E0002X, 2278G1100X, 2278P3900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2278G1100X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | General Care |
No | 227800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | |
No | 2278C0205X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Critical Care |
No | 2278E0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Emergency Care |
No | 2278P3900X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Neonatal/Pediatrics |