Provider Demographics
NPI:1649444175
Name:QADADAH, KRISTEN LEIGH (RN)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEIGH
Last Name:QADADAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL RD FL 6
Mailing Address - Street 2:DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-2552
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL RD FL 6
Practice Address - Street 2:DWIGHT D EISENHOWER ARMY MEDICAL CENTER
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174951163W00000X
CA623606163W00000X
CA67313163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health