Healthcare Provider Details

I. General information

NPI: 1356378483
Provider Name (Legal Business Name): KRISTINA L KRUCHOWSKI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 S. FERN ST. SUITE 200
WASILLA AK
99654-8589
US

IV. Provider business mailing address

2341 S. FERN ST. SUITE 200
WASILLA AK
99654-8589
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-1999
  • Fax: 907-357-1990
Mailing address:
  • Phone: 907-357-1999
  • Fax: 907-357-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26581
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number950
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: