Provider Demographics
NPI:1639799935
Name:NASTAJ, KRISTA MARIE (MSN, RN, CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:MARIE
Last Name:NASTAJ
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MARIE
Other - Last Name:VAN BAREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 INNES ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3516
Mailing Address - Country:US
Mailing Address - Phone:616-633-6795
Mailing Address - Fax:
Practice Address - Street 1:414 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3350
Practice Address - Country:US
Practice Address - Phone:219-326-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28258470A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics