Provider Demographics
NPI:1770830978
Name:KRYSKALLA, ELIZABETH ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KRYSKALLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N WILLIAMSON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5297
Mailing Address - Country:US
Mailing Address - Phone:928-541-2293
Mailing Address - Fax:928-717-3284
Practice Address - Street 1:1800 N WILLIAMSON VALLEY RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-5297
Practice Address - Country:US
Practice Address - Phone:928-541-2293
Practice Address - Fax:928-717-3284
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN152473163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool