Provider Demographics
NPI:1639332596
Name:PRINCE, KRISTINA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:PRINCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:ALAN
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:626 CORDOVA ST
Mailing Address - Street 2:STE104
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3715
Mailing Address - Country:US
Mailing Address - Phone:907-375-0930
Mailing Address - Fax:
Practice Address - Street 1:626 CORDOVA ST
Practice Address - Street 2:STE104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3715
Practice Address - Country:US
Practice Address - Phone:907-375-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist