Healthcare Provider Details

I. General information

NPI: 1558494393
Provider Name (Legal Business Name): KRISTINA MARIE WOODS PHD, RN, CLNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA MARIE WOODS REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31156 CHESAPEAKE LN
MENTONE CA
92359-1536
US

IV. Provider business mailing address

932 KENSINGTON DR
REDLANDS CA
92374-4906
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-3775
  • Fax:
Mailing address:
  • Phone: 909-798-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberRN269545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: