1558494393 NPI number — DR. KRISTINA MARIE WOODS PHD, RN, CLNC

Table of content: DR. KRISTINA MARIE WOODS PHD, RN, CLNC (NPI 1558494393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558494393 NPI number — DR. KRISTINA MARIE WOODS PHD, RN, CLNC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
KRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, RN, CLNC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODS
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1558494393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 KENSINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92374-4906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-798-3775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31156 CHESAPEAKE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENTONE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92359-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-798-3775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007

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: 174H00000X , with the licence number:  RN269545 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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