Provider Demographics
NPI:1891402814
Name:INGEBRETSEN, KRISTIAN ALLEN (RN, SRNA)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:ALLEN
Last Name:INGEBRETSEN
Suffix:
Gender:M
Credentials:RN, SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 N AMERICAN ST UNIT 404
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1680
Mailing Address - Country:US
Mailing Address - Phone:206-794-5902
Mailing Address - Fax:
Practice Address - Street 1:1136 N AMERICAN ST UNIT 404
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1680
Practice Address - Country:US
Practice Address - Phone:206-794-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program