Provider Demographics
NPI:1992229645
Name:KITANO, KRISTINA (CRNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KITANO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 CHESTNUT STREET
Mailing Address - Street 2:RALSTON PENN CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2612
Mailing Address - Country:US
Mailing Address - Phone:215-662-2746
Mailing Address - Fax:215-349-5648
Practice Address - Street 1:3615 CHESTNUT STREET
Practice Address - Street 2:RALSTON PENN CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2612
Practice Address - Country:US
Practice Address - Phone:215-662-2746
Practice Address - Fax:215-349-5648
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016082363LF0000X
NJ26NJ00636400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily