Healthcare Provider Details

I. General information

NPI: 1922606961
Provider Name (Legal Business Name): KRISTI L KRUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTI ANDERSON

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 HILLVIEW TER
BUFFALO NY
14224-2849
US

IV. Provider business mailing address

135 HILLVIEW TER
BUFFALO NY
14224-2849
US

V. Phone/Fax

Practice location:
  • Phone: 716-989-8651
  • Fax:
Mailing address:
  • Phone: 716-989-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number627509
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number627509
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number627509
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number627509
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number627509
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number627509
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number627509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: