Provider Demographics
NPI:1730460981
Name:BANFIELD, KRYSTYNA (APN-C)
Entity Type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:
Last Name:BANFIELD
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 N SAILORS QUAY DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4707
Mailing Address - Country:US
Mailing Address - Phone:732-920-4314
Mailing Address - Fax:
Practice Address - Street 1:62 N SAILORS QUAY DR
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4707
Practice Address - Country:US
Practice Address - Phone:732-920-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00342800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health