Provider Demographics
NPI:1841828720
Name:MENGWASSER, KRISTEN ELIZABETH
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:MENGWASSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 POND AVE APT 1006
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7158
Mailing Address - Country:US
Mailing Address - Phone:314-809-8201
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVENUE BLDG 90 FL2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:628-206-4777
Practice Address - Fax:628-206-4257
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program