Healthcare Provider Details

I. General information

NPI: 1720051139
Provider Name (Legal Business Name): KRISTI ANN MASTERSON RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY ROAD BASSETT ARMY COMMUNITY HOSPITAL
FORT WAINWRIGHT AK
99703-4845
US

IV. Provider business mailing address

1060 GAFFNEY ROAD COMMANDER, USA-MEDDAC,AK, ATTN; MCUC-MMD-QM
FORT WAINWRIGHT AK
99703-4845
US

V. Phone/Fax

Practice location:
  • Phone: 907-353-5158
  • Fax:
Mailing address:
  • Phone: 907-353-5418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number13-71060-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: