Provider Demographics
NPI:1932203213
Name:KLAMAR, KRISTIN N (PAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:KLAMAR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N 18TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3734
Mailing Address - Country:US
Mailing Address - Phone:602-795-7246
Mailing Address - Fax:
Practice Address - Street 1:525 N 18TH ST STE 304
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3734
Practice Address - Country:US
Practice Address - Phone:602-795-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2849363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
80744Medicare ID - Type Unspecified
Q15723Medicare UPIN