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NPI Code Detail

MEDICARE: KRISTINE MUA RN

MEDICARE: KRISTINE MUA RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse10039394OR

General Provider Information

NPI Number : 1235093758
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE MUA RN
Provider Business Mailing Address
First Line : 4104 SE 82ND AVE STE 250
Second Line :
City : PORTLAND
State : OR
Zip : 97266-2954
Country : US
Telephone Number : 503-215-9850
Fax Number :
Provider Business Practice Location Address
First Line : 4104 SE 82ND AVE STE 250
Second Line :
City : PORTLAND
State : OR
Zip : 97266-2954
Country : US
Telephone Number : 503-215-9850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2025
Last Update Date : 12/10/2025

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