Healthcare Provider Details

I. General information

NPI: 1114392842
Provider Name (Legal Business Name): KRISTA DAE STIEGLITZ RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 KEAHOLE ST
HONOLULU HI
96825-3405
US

IV. Provider business mailing address

2130 NW FRITZ PL
CORVALLIS OR
97330-2284
US

V. Phone/Fax

Practice location:
  • Phone: 808-395-4427
  • Fax:
Mailing address:
  • Phone: 541-908-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201041541RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2999
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201905115NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: