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General NPI Number Information
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NPI Number | 1013207489
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Entity Type | Individual
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Provider Name | DEANNA JANE KRISTOFIC PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 167 NORTH MAIN STREET
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City | TUBA CITY
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State | AZ
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Zip | 86045-0600
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Country | US
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Telephone | 928-283-2501
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Fax |
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Provider Business Mailing Address
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Address Line | 4680 ABLE AVE
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City | KANAB
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State | UT
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Zip | 84741-8161
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Country | US
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Telephone | 928-640-7914
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP4267
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License Number State | AZ
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