Provider Demographics
NPI:1265280804
Name:VACA, KRISTINA (LPN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:VACA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 RELENTE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1178
Mailing Address - Country:US
Mailing Address - Phone:760-983-1733
Mailing Address - Fax:
Practice Address - Street 1:250 PILOT RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3514
Practice Address - Country:US
Practice Address - Phone:702-982-3292
Practice Address - Fax:702-982-5286
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV870649164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse