Provider Demographics
NPI:1215452826
Name:HINTZSCHE, KRISTINA LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LYNN
Last Name:HINTZSCHE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LYNN
Other - Last Name:DEMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2920 VIGILANTE AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-3112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8608
Practice Address - Country:US
Practice Address - Phone:662-550-4299
Practice Address - Fax:662-580-4324
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING367500000X
CA95000757367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty