Provider Demographics
NPI:1922374727
Name:STELLA, KRISTIN E (LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:STELLA
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-5702
Mailing Address - Country:US
Mailing Address - Phone:941-448-8811
Mailing Address - Fax:
Practice Address - Street 1:6907 22ND ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5702
Practice Address - Country:US
Practice Address - Phone:941-448-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-29580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist