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General NPI Number Information
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NPI Number | 1043524689
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Entity Type | Individual
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Provider Name | KRISTA MARIE SIMONETTI MS, CNS
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Gender | Female
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 540 N CAMINO MERCADO SUITE 3
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5751
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Country | US
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Telephone | 520-840-4026
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Fax |
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Provider Business Mailing Address
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Address Line | 15801 S 48TH ST APT 2212
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City | PHOENIX
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State | AZ
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Zip | 85048-0807
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Country | US
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Telephone | 480-204-6006
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | CNS-16014
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License Number State | AZ
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