Provider Demographics
NPI:1639382682
Name:WILLS, KRISTA O (MT,SM(ASCP)CLS)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:O
Last Name:WILLS
Suffix:
Gender:F
Credentials:MT,SM(ASCP)CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-829-8659
Mailing Address - Fax:
Practice Address - Street 1:CURRY HEALTH CENTER - UNIVERSITY OF MONTANA
Practice Address - Street 2:643 EDDY AVE
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812
Practice Address - Country:US
Practice Address - Phone:406-243-2778
Practice Address - Fax:406-243-2726
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT117246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist