Provider Demographics
NPI:1992973796
Name:HARBOUR, KRISTINA M
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:HARBOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIO
Other - Middle Name:S
Other - Last Name:HARBOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18042 W MORNING VISTA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-6377
Mailing Address - Country:US
Mailing Address - Phone:602-708-7105
Mailing Address - Fax:
Practice Address - Street 1:18042 W MORNING VISTA LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-6377
Practice Address - Country:US
Practice Address - Phone:602-708-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ455928385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child