Healthcare Provider Details

I. General information

NPI: 1861787988
Provider Name (Legal Business Name): KRISTIN NICOLE MAHIN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UNIVERSAL CITY PLZ
UNIVERSAL CITY CA
91608-1002
US

IV. Provider business mailing address

300 45TH ST S
FARGO ND
58103-1189
US

V. Phone/Fax

Practice location:
  • Phone: 360-509-9908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberABA-IN-10255706
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: