Provider Demographics
NPI:1336267368
Name:KRISTY, ANNE C (CRNA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:KRISTY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:C
Other - Last Name:MENTELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:923 BURGS PARK DR
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-9182
Mailing Address - Country:US
Mailing Address - Phone:715-468-4594
Mailing Address - Fax:
Practice Address - Street 1:819 ASH ST
Practice Address - Street 2:SPOONER HEALTH SYSTEM
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1201
Practice Address - Country:US
Practice Address - Phone:715-635-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI95542-030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered