Provider Demographics
NPI:1710608468
Name:MAGILL, KRISTINE D
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:D
Last Name:MAGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ELECTRONICS PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6001
Mailing Address - Country:US
Mailing Address - Phone:315-432-5636
Mailing Address - Fax:315-432-0916
Practice Address - Street 1:417 ELECTRONICS PKWY
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6001
Practice Address - Country:US
Practice Address - Phone:315-432-5636
Practice Address - Fax:315-432-0916
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508529-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse