Provider Demographics
NPI:1942473541
Name:GURGANIOUS, KRISTINA LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEIGH
Last Name:GURGANIOUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LEIGH
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 LYNNDALE CT STE F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5443
Mailing Address - Country:US
Mailing Address - Phone:252-353-8001
Mailing Address - Fax:252-353-7923
Practice Address - Street 1:600 LYNNDALE CT STE F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5443
Practice Address - Country:US
Practice Address - Phone:252-353-8001
Practice Address - Fax:252-353-7923
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid