Provider Demographics
NPI:1699048736
Name:DZIEDZIC, KRISTA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:MARIE
Last Name:DZIEDZIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1423
Mailing Address - Country:US
Mailing Address - Phone:610-998-1807
Mailing Address - Fax:610-998-1808
Practice Address - Street 1:35 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1423
Practice Address - Country:US
Practice Address - Phone:610-998-1807
Practice Address - Fax:610-998-1808
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN622649163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent