Provider Demographics
NPI:1457514416
Name:FERULLO, KRISTAN LEE (RN, CDE)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:LEE
Last Name:FERULLO
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:KRISTAN
Other - Middle Name:LEE
Other - Last Name:EISAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-4478
Mailing Address - Fax:603-740-2244
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-740-4478
Practice Address - Fax:603-740-2244
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH028810-21163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator