Provider Demographics
NPI:1750581294
Name:VENICK, KRISTEN CAMPBELL (CPNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:CAMPBELL
Last Name:VENICK
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:MDCC A2-410
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-6708
Mailing Address - Fax:310-206-8089
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:MDCC A2-410
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-6708
Practice Address - Fax:310-206-8089
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14304363LP0222X
CA2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology