Provider Demographics
NPI:1982743316
Name:CHRISTIANSON, KRISTA LYNN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LYNN
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:LYNN
Other - Last Name:KOPACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2695 EMERALD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1472
Mailing Address - Country:US
Mailing Address - Phone:707-372-2377
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:10TH MEDICAL GROUP
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3482367500000X
CO0994535367500000X
CA535669367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered