Provider Demographics
NPI:1962870071
Name:DUBETZ, KRYSTYNA
Entity type:Individual
Prefix:MISS
First Name:KRYSTYNA
Middle Name:
Last Name:DUBETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66400 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-3138
Mailing Address - Country:US
Mailing Address - Phone:740-424-7009
Mailing Address - Fax:
Practice Address - Street 1:66400 7TH ST
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3138
Practice Address - Country:US
Practice Address - Phone:740-424-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290625164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse