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General NPI Number Information
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NPI Number | 1639799935
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Entity Type | Individual
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Provider Name | KRISTA MARIE NASTAJ MSN, RN, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 09/18/2022
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Provider Practice Location Address
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Address Line | 414 LINCOLNWAY
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City | LA PORTE
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State | IN
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Zip | 46350-3350
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Country | US
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Telephone | 219-326-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 750 INNES ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3516
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Country | US
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Telephone | 616-633-6795
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 28258470A
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License Number State | IN
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