Healthcare Provider Details

I. General information

NPI: 1003162181
Provider Name (Legal Business Name): DIANNA ELKENBAUM KRISTELLER CNM, DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNA ELKENBAUM KRISTELLER CNM, DNP, APRN

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 11/10/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559
US

IV. Provider business mailing address

PO BOX 1275
BETHEL AK
99559-1275
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6000
  • Fax:
Mailing address:
  • Phone: 907-545-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1319
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1319
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: