1871125054 NPI number — KRISTAL PLATT LCGC

Table of content: MEGAN MARIE PREDINA CRNA (NPI 1265778559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871125054 NPI number — KRISTAL PLATT LCGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLATT
Provider First Name:
KRISTAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871125054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N 30TH ST
Provider Second Line Business Mailing Address:
BOYS TOWN NATIONAL RESEARCH HOSPITAL
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68131-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
531-355-6365
Provider Business Mailing Address Fax Number:
531-355-5028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N 30TH ST
Provider Second Line Business Practice Location Address:
BOYS TOWN NATIONAL RESEARCH HOSPITAL
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68131-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
531-355-6365
Provider Business Practice Location Address Fax Number:
531-355-5028
Provider Enumeration Date:
02/06/2020

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: 170300000X , with the licence number:  16 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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