Provider Demographics
NPI:1952047581
Name:MANOOKIAN, KRISTY (RN)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:
Last Name:MANOOKIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4136 495 ALLWOOD RD.
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-9998
Mailing Address - Country:US
Mailing Address - Phone:862-571-0456
Mailing Address - Fax:
Practice Address - Street 1:21 GREGLAWN DR
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2504
Practice Address - Country:US
Practice Address - Phone:862-571-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05903500164W00000X
NJ26NR24924700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse