Provider Demographics
NPI:1659054898
Name:GUNSOLUS, KRISTINA FAYE (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:FAYE
Last Name:GUNSOLUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:ELDRED
Mailing Address - State:PA
Mailing Address - Zip Code:16731-0052
Mailing Address - Country:US
Mailing Address - Phone:814-331-6989
Mailing Address - Fax:
Practice Address - Street 1:179 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELDRED
Practice Address - State:PA
Practice Address - Zip Code:16731-4519
Practice Address - Country:US
Practice Address - Phone:814-331-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310354-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse