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General NPI Number Information
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NPI Number | 1952411647
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Entity Type | Individual
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Provider Name | KRISTINE RENEE MAGGI PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 2091 BOX BUTTE AVE STE 700
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City | ALLIANCE
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State | NE
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Zip | 69301-4458
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Country | US
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Telephone | 308-762-7244
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Fax | 308-761-1249
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Provider Business Mailing Address
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Address Line | 760 W 57TH ST
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City | CASPER
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State | WY
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Zip | 82601-6445
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Country | US
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Telephone | 307-871-9300
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Fax | 855-733-2371
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 290
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2412
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License Number State | NE
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