Provider Demographics
NPI:1053619239
Name:DAVIS, KRISTIN VIRGINIA (RN)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:VIRGINIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:VIRGINIA
Other - Last Name:LANGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:480 CENTRAL AVE
Mailing Address - Street 2:ATTN MEDICAL STAFF SERVICES PROF- RM218
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:808-471-1866
Mailing Address - Fax:808-471-0918
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:ATTN MEDICAL STAFF SERVICES PROF- RM218
Practice Address - City:J B P H H
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-471-1866
Practice Address - Fax:808-471-0918
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543277163W00000X
HIRN-68819163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care