Healthcare Provider Details

I. General information

NPI: 1174951131
Provider Name (Legal Business Name): KRISTI L ALTHOF CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 MYRTLE ST STE 100
ERIE PA
16502-2700
US

IV. Provider business mailing address

2508 MYRTLE ST STE 100
ERIE PA
16502-2700
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-7134
  • Fax: 814-454-2003
Mailing address:
  • Phone: 814-452-7134
  • Fax: 814-454-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013307
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: