Provider Demographics
NPI:1023679701
Name:ANDERSON, KRISTIN ANN (RN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:ANDERSON
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 1:426 WHEATFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-7017
Mailing Address - Country:US
Mailing Address - Phone:716-400-2562
Mailing Address - Fax:
Practice Address - Street 1:426 WHEATFIELD ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-7017
Practice Address - Country:US
Practice Address - Phone:716-400-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse