Provider Demographics
NPI:1740453612
Name:MCDONALD, KRISTIN NICHOLE (HS3)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICHOLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:HS3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9436
Mailing Address - Country:US
Mailing Address - Phone:907-966-5438
Mailing Address - Fax:907-966-5491
Practice Address - Street 1:611 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9436
Practice Address - Country:US
Practice Address - Phone:907-966-5438
Practice Address - Fax:907-966-5491
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK07229005146M00000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate