Healthcare Provider Details

I. General information

NPI: 1578749735
Provider Name (Legal Business Name): KRISTIE LYNN NORDIN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE LYNN FAVRO

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6907 MARTHA AVE
CHATTANOOGA TN
37412-4031
US

IV. Provider business mailing address

6907 MARTHA AVE
CHATTANOOGA TN
37412-4031
US

V. Phone/Fax

Practice location:
  • Phone: 518-335-1433
  • Fax:
Mailing address:
  • Phone: 518-335-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: