Provider Demographics
NPI:1760756167
Name:KRISS, MARY BETH
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:KRISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:WEATHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 KENDRICK LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3574
Mailing Address - Country:US
Mailing Address - Phone:603-554-8085
Mailing Address - Fax:603-882-0556
Practice Address - Street 1:5 COLISEUM AVE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3292
Practice Address - Country:US
Practice Address - Phone:603-882-9800
Practice Address - Fax:603-882-0556
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC112901246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist