Provider Demographics
NPI:1952521288
Name:KRITKAUSKY, LORRAINE DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:DIANE
Last Name:KRITKAUSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:DIANE
Other - Last Name:INGRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4326 W CORRINE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2128
Mailing Address - Country:US
Mailing Address - Phone:602-938-2834
Mailing Address - Fax:
Practice Address - Street 1:4650 WEST SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-347-2600
Practice Address - Fax:602-347-2709
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN042770163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ559114Medicaid