Provider Demographics
NPI:1376386722
Name:ALMANZA, KRISTINA RAE (APRN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RAE
Last Name:ALMANZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 CORNROW LN
Mailing Address - Street 2:
Mailing Address - City:COMBINED LOCKS
Mailing Address - State:WI
Mailing Address - Zip Code:54113-1415
Mailing Address - Country:US
Mailing Address - Phone:920-205-2728
Mailing Address - Fax:
Practice Address - Street 1:5045 W GRANDE MARKET DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8517
Practice Address - Country:US
Practice Address - Phone:920-886-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15450-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner