Provider Demographics
NPI:1942550934
Name:IANNETTA, KRISTA LYNN (TSHH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LYNN
Last Name:IANNETTA
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 831 128 WEST MAIN STREET
Mailing Address - Street 2:APARTMENT 2;
Mailing Address - City:BROWNVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13615-0831
Mailing Address - Country:US
Mailing Address - Phone:315-767-1707
Mailing Address - Fax:
Practice Address - Street 1:16783 IVES STREET ROAD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-788-5377
Practice Address - Fax:315-788-5373
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist