MEDICARE: KRISTIN CLIFT DUVALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R209482	MD
2	363LF0000X	Family Nurse Practitioner	SP019273	PA

General Provider Information

NPI Number	:	1720573231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN CLIFT DUVALL

Provider Business Mailing Address
First Line	:	2030 THISTLE HILL DR
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-1159
Country	:	US
Telephone Number	:	717-225-9869
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 THISTLE HILL DR
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-1159
Country	:	US
Telephone Number	:	717-225-9869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	12/12/2020

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Directions to “ KRISTIN CLIFT DUVALL ” Practice Location

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