Provider Demographics
NPI:1720443765
Name:OUANO, KRISTINA PACHMAN (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:PACHMAN
Last Name:OUANO
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5219
Mailing Address - Country:US
Mailing Address - Phone:908-309-2850
Mailing Address - Fax:
Practice Address - Street 1:25 GERALD AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5219
Practice Address - Country:US
Practice Address - Phone:908-309-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430972363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care