Provider Demographics
NPI:1720573231
Name:DUVALL, KRISTIN CLIFT
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CLIFT
Last Name:DUVALL
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 1:2030 THISTLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-1159
Mailing Address - Country:US
Mailing Address - Phone:717-225-9869
Mailing Address - Fax:
Practice Address - Street 1:2030 THISTLE HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-1159
Practice Address - Country:US
Practice Address - Phone:717-225-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209482363LF0000X
PASP019273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily