Provider Demographics
NPI:1922335868
Name:WHITFIELD, KRISTIN (LICAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02662
Mailing Address - Country:US
Mailing Address - Phone:774-722-0423
Mailing Address - Fax:508-945-7711
Practice Address - Street 1:46 CROWELL ROAD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633
Practice Address - Country:US
Practice Address - Phone:774-722-0423
Practice Address - Fax:508-945-7711
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216123171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist