Provider Demographics
NPI:1487378089
Name:NENADAL, KRISTY DEAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:DEAN
Last Name:NENADAL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:DEAN
Other - Last Name:RUFFING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13692 HEWES AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2774
Mailing Address - Country:US
Mailing Address - Phone:619-244-0773
Mailing Address - Fax:
Practice Address - Street 1:13692 HEWES AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-2774
Practice Address - Country:US
Practice Address - Phone:619-244-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMN7644811OtherDEA