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General NPI Number Information
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NPI Number | 1407597917
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Entity Type | Individual
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Provider Name | KRISTIN GRAZINA PRUNSKIS MD
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 516 E NIZHONI BLVD
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City | GALLUP
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State | NM
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Zip | 87301-5748
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Country | US
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Telephone | 505-722-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7259 S BINGHAM JUNCTION BLVD
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City | MIDVALE
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State | UT
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Zip | 84047-4860
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD2025-0530
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License Number State | NM
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