Healthcare Provider Details

I. General information

NPI: 1831428515
Provider Name (Legal Business Name): KRISTIN BERKNER ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21820 S ELLSWORTH RD SUITE 101
QUEEN CREEK AZ
85142-6177
US

IV. Provider business mailing address

18704 E MARY ANN WAY
QUEEN CREEK AZ
85142-9459
US

V. Phone/Fax

Practice location:
  • Phone: 480-296-6173
  • Fax: 480-677-8310
Mailing address:
  • Phone: 480-250-1924
  • Fax: 480-677-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number09-1135
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: