Provider Demographics
NPI:1295107928
Name:MITSUI, KRISTY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MITSUI
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:BEAUDOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:159 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5813
Mailing Address - Country:US
Mailing Address - Phone:207-873-5437
Mailing Address - Fax:207-861-5448
Practice Address - Street 1:159 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5813
Practice Address - Country:US
Practice Address - Phone:207-873-5437
Practice Address - Fax:207-861-5448
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151155363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics