Provider Demographics
NPI:1285978429
Name:SOBALLE, KRISTINA (RN)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:SOBALLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 N 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-7158
Mailing Address - Country:US
Mailing Address - Phone:206-683-9723
Mailing Address - Fax:
Practice Address - Street 1:2010 N 88TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6102
Practice Address - Country:US
Practice Address - Phone:402-496-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74820163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse