Provider Demographics
NPI:1780650234
Name:IMPERIO, KRISTAL L (NP)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:L
Last Name:IMPERIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:978-466-3212
Mailing Address - Fax:978-534-3581
Practice Address - Street 1:165 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-3212
Practice Address - Fax:978-534-3581
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198129363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
4142192OtherMVP HEALTH CARE
NP3714OtherBLUE SHIELD HMO BLUE
NP3714OtherBLUE SHIELD INDEMNITY
042472266OtherTHREE RIVERS
0390411OtherWELFARE
MA0390411Medicaid
042472266OtherTRICARE
NP3714OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYSTEM
61994OtherFALLON COMMUNITY HEALTH P
042472266OtherCHAMPUS
AA3666OtherHARVARD PILGRIM HEALTHCAR
042472266OtherTRICARE
500024147Medicare ID - Type UnspecifiedRAILROAD
MANP3714Medicare ID - Type Unspecified
042472266OtherTHREE RIVERS