MEDICARE: KRISTA HOLLIS CRNP

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	363L00000X	Nurse Practitioner	SP013058	PA

General Provider Information

NPI Number	:	1992138135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA HOLLIS CRNP

Provider Business Mailing Address
First Line	:	601 PARK ST
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1445
Country	:	US
Telephone Number	:	570-253-8226
Fax Number	:	570-253-8228

Provider Business Practice Location Address
First Line	:	100 DUNDAFF ST
Second Line	:
City	:	FOREST CITY
State	:	PA
Zip	:	18421-1317
Country	:	US
Telephone Number	:	570-785-3194
Fax Number	:	570-785-9775

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	04/06/2023

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