Healthcare Provider Details

I. General information

NPI: 1114099579
Provider Name (Legal Business Name): KRISTINE MARIE DORIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

301 HOLLY HILL RD
RICHBORO PA
18954-1967
US

V. Phone/Fax

Practice location:
  • Phone: 800-637-2374
  • Fax:
Mailing address:
  • Phone: 215-301-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ01135500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: