Provider Demographics
NPI:1386466977
Name:ANDERSON, KRISTINA LOVE (DOULA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LOVE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3072
Mailing Address - Country:US
Mailing Address - Phone:309-429-5958
Mailing Address - Fax:
Practice Address - Street 1:1019 14TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3072
Practice Address - Country:US
Practice Address - Phone:309-429-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula