Provider Demographics
NPI:1891829487
Name:KRISS, COLLEEN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARIE
Last Name:KRISS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:AALBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1520 VIRGINIA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5731
Mailing Address - Country:US
Mailing Address - Phone:775-782-1550
Mailing Address - Fax:
Practice Address - Street 1:1649 LUCERNE ST
Practice Address - Street 2:UNIT A & B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4369
Practice Address - Country:US
Practice Address - Phone:775-782-1603
Practice Address - Fax:775-782-3417
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVDO1416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV293811Medicare PIN
NVBE036ZMedicare PIN