Provider Demographics
NPI:1558650705
Name:ANDERSON-CRONIN, KRISTIN A (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:A
Last Name:ANDERSON-CRONIN
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 GERSHWIN DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4328
Mailing Address - Country:US
Mailing Address - Phone:920-391-6940
Mailing Address - Fax:
Practice Address - Street 1:3150 GERSHWIN DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4328
Practice Address - Country:US
Practice Address - Phone:920-391-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170979-030163W00000X
WI5424-33163WP0808X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1558650705Medicaid
WI000001545OtherMEDICARE
WI000001545OtherMEDICARE