MEDICARE: KRISTINE SUDARIA 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
1	163W00000X	Registered Nurse	NURR34173	AK

General Provider Information

NPI Number	:	1558241604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE SUDARIA RN

Provider Business Mailing Address
First Line	:	3507 MCKENZIE DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3507 MCKENZIE DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1654
Country	:	US
Telephone Number	:	337-424-0194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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