1891829487 NPI number — DR. COLLEEN MARIE KRISS D.O.

Table of content: DR. COLLEEN MARIE KRISS D.O. (NPI 1891829487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891829487 NPI number — DR. COLLEEN MARIE KRISS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISS
Provider First Name:
COLLEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AALBERS
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891829487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 VIRGINIA RANCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDNERVILLE
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89410-5731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-782-1550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1649 LUCERNE ST
Provider Second Line Business Practice Location Address:
UNIT A & B
Provider Business Practice Location Address City Name:
MINDEN
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89423-4369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-782-1603
Provider Business Practice Location Address Fax Number:
775-782-3417
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: DO1416 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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