Provider Demographics
NPI:1942673942
Name:KLOPOTEK, KRISTA LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LEE
Last Name:KLOPOTEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:LEE
Other - Last Name:GERSTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 MEMORIAL PARKWAY
Mailing Address - Street 2:UTICA CITY SCHOOL DISTRICT
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-792-2210
Mailing Address - Fax:
Practice Address - Street 1:1151 ALBANY STREET
Practice Address - Street 2:ALBANY ELEMENTARY SCHOOL
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501
Practice Address - Country:US
Practice Address - Phone:315-792-2150
Practice Address - Fax:315-792-2151
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY694656163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse