Healthcare Provider Details

I. General information

NPI: 1316970577
Provider Name (Legal Business Name): KRISTINE ELLE HEMBRE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 PROFESSIONAL PL SUITE # 103
COLORADO SPRINGS CO
80904-8126
US

IV. Provider business mailing address

2925 PROFESSIONAL PL SUITE # 103
COLORADO SPRINGS CO
80904-8126
US

V. Phone/Fax

Practice location:
  • Phone: 719-593-1234
  • Fax: 719-578-0999
Mailing address:
  • Phone: 719-593-1234
  • Fax: 719-578-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number30065
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: