Healthcare Provider Details

I. General information

NPI: 1528887221
Provider Name (Legal Business Name): KRISTI RENE'E DREIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DONALDS WAY STE 208
EAST BRIDGEWATER MA
02333-1478
US

IV. Provider business mailing address

334 PLEASANT ST
STOUGHTON MA
02072-2541
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-1701
  • Fax: 781-871-0312
Mailing address:
  • Phone: 508-577-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN100284
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: