Healthcare Provider Details

I. General information

NPI: 1992702468
Provider Name (Legal Business Name): KRISTIN STANISZEWSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD STE 170
PHOENIX AZ
85032-9385
US

IV. Provider business mailing address

4550 E BELL RD STE 170
PHOENIX AZ
85032-9385
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-8400
  • Fax: 480-443-8697
Mailing address:
  • Phone: 480-443-8400
  • Fax: 480-443-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberP62779
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP9600
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: