Provider Demographics
NPI:1932863149
Name:DE LA CRUZ, KRISTIN LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LEE
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 NY-22B
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962
Mailing Address - Country:US
Mailing Address - Phone:518-563-8000
Mailing Address - Fax:518-561-3490
Practice Address - Street 1:2155 NY-22B
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962
Practice Address - Country:US
Practice Address - Phone:518-563-8000
Practice Address - Fax:518-561-3490
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324014164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse