Provider Demographics
NPI:1972727956
Name:ZOLNOSKI, KRISTAN LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAN
Middle Name:LYNN
Last Name:ZOLNOSKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:KRISTAN
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:RR 1 BOX 734
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-9623
Mailing Address - Country:US
Mailing Address - Phone:814-793-4639
Mailing Address - Fax:
Practice Address - Street 1:501 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6410
Practice Address - Country:US
Practice Address - Phone:814-944-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006305174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist