Healthcare Provider Details

I. General information

NPI: 1467168369
Provider Name (Legal Business Name): KRISTINE NAE UY PEDRAJAS BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHOTDA COURT, LIGUAN TERRACE
DEDEDO GU
96921
US

IV. Provider business mailing address

PO BOX 27084
BARRIGADA GU
96921-6943
US

V. Phone/Fax

Practice location:
  • Phone: 671-777-2587
  • Fax:
Mailing address:
  • Phone: 671-777-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRE1384
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: