Provider Demographics
NPI:1841780988
Name:IGWEIKE, KRISTINA LYNN
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LYNN
Last Name:IGWEIKE
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 1:2314 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-4124
Mailing Address - Country:US
Mailing Address - Phone:804-918-5474
Mailing Address - Fax:804-716-7261
Practice Address - Street 1:2314 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4124
Practice Address - Country:US
Practice Address - Phone:804-918-5474
Practice Address - Fax:804-716-7261
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)