Provider Demographics
NPI:1891866026
Name:JABLONSKI, KRISTINE LYNE (APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:LYNE
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 E DATE ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-6305
Mailing Address - Country:US
Mailing Address - Phone:714-524-0539
Mailing Address - Fax:714-524-0539
Practice Address - Street 1:101 S KRAEMER BLVD
Practice Address - Street 2:SUITE 123
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6105
Practice Address - Country:US
Practice Address - Phone:714-524-0539
Practice Address - Fax:714-524-0539
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN296282163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA277OtherCA BRN REGISTERED
CACNS27Medicare ID - Type Unspecified