Provider Demographics
NPI:1922862804
Name:NEBRIJA, KRISTINE (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:NEBRIJA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9775
Mailing Address - Country:US
Mailing Address - Phone:217-433-0134
Mailing Address - Fax:
Practice Address - Street 1:525 VENTURA DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9775
Practice Address - Country:US
Practice Address - Phone:217-433-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner