Provider Demographics
NPI:1699106278
Name:BARBARO, KRISTINA A (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:A
Last Name:BARBARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:A
Other - Last Name:WILDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-283-7000
Mailing Address - Fax:207-286-9853
Practice Address - Street 1:13 INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072
Practice Address - Country:US
Practice Address - Phone:207-283-8800
Practice Address - Fax:207-286-9853
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP131054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1699106278Medicaid
MEE400136137Medicare PIN