Provider Demographics
NPI:1407383896
Name:VOLLMER, KRISTINE LYNN (APRN)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LYNN
Last Name:VOLLMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 E IRMA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4312
Mailing Address - Country:US
Mailing Address - Phone:480-890-5800
Mailing Address - Fax:
Practice Address - Street 1:4375 E IRMA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4312
Practice Address - Country:US
Practice Address - Phone:480-890-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ305567363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health