Provider Demographics
NPI:1922111962
Name:KRISTIANSEN, JOANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:KRISTIANSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 COLD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1406
Mailing Address - Country:US
Mailing Address - Phone:573-686-5550
Mailing Address - Fax:
Practice Address - Street 1:1305 WALL ST STE 101
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3853
Practice Address - Country:US
Practice Address - Phone:573-686-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28098027367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74002106Medicaid
KY000000075946OtherKY BCBS
IN000000075946OtherIN BCBS
KY74002106Medicaid
IN000000075946OtherIN BCBS