Healthcare Provider Details

I. General information

NPI: 1558650705
Provider Name (Legal Business Name): KRISTIN A. ANDERSON-CRONIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 GERSHWIN DR
GREEN BAY WI
54311-4328
US

IV. Provider business mailing address

3150 GERSHWIN DR
GREEN BAY WI
54311-4328
US

V. Phone/Fax

Practice location:
  • Phone: 920-391-6940
  • Fax:
Mailing address:
  • Phone: 920-391-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number170979-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number5424-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5424-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: