Provider Demographics
NPI:1922606961
Name:KRUPP, KRISTI L
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:KRUPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 HILLVIEW TER
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2849
Mailing Address - Country:US
Mailing Address - Phone:716-989-8651
Mailing Address - Fax:
Practice Address - Street 1:135 HILLVIEW TER
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14224-2849
Practice Address - Country:US
Practice Address - Phone:716-989-8651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627509163WC0200X, 163WD1100X, 163WH1000X, 163WN0002X, 163WN0003X, 163WP0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP0200XNursing Service ProvidersRegistered NursePediatrics