Provider Demographics
NPI:1902205065
Name:EL-CHEMOR, KRISTINA LOUISE (CST)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:LOUISE
Last Name:EL-CHEMOR
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E SHEVLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-3026
Mailing Address - Country:US
Mailing Address - Phone:248-275-6554
Mailing Address - Fax:
Practice Address - Street 1:611 E SHEVLIN AVE
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-3026
Practice Address - Country:US
Practice Address - Phone:248-275-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115463246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAST 60487918OtherWASHINGTON STATE DEPT OF HEALTH SURGICAL TECHNOLOGY REGISTRATION
CO115463OtherNBSTSA