Provider Demographics
NPI:1265198428
Name:REARDON, KRYSTINE (RN)
Entity type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:
Last Name:REARDON
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 1:7 SAINT JAMES PL APT 720
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-4611
Mailing Address - Country:US
Mailing Address - Phone:339-927-2101
Mailing Address - Fax:
Practice Address - Street 1:116 SPIT BROOK RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2711
Practice Address - Country:US
Practice Address - Phone:603-891-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH085547-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse