Provider Demographics
NPI:1750726428
Name:MAULDING, KRISTI (RN)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MAULDING
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 1:2055 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-2346
Mailing Address - Country:US
Mailing Address - Phone:503-957-9425
Mailing Address - Fax:
Practice Address - Street 1:2055 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-2346
Practice Address - Country:US
Practice Address - Phone:503-957-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201340070RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse