Provider Demographics
NPI:1336348754
Name:KLAFEHN, KRISTINE ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ANN
Last Name:KLAFEHN
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 1:1363 BROOKEDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:NY
Mailing Address - Zip Code:14464-9361
Mailing Address - Country:US
Mailing Address - Phone:585-964-2113
Mailing Address - Fax:
Practice Address - Street 1:1363 BROOKEDGE DR
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:NY
Practice Address - Zip Code:14464-9361
Practice Address - Country:US
Practice Address - Phone:585-964-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174742-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01705628Medicaid