Provider Demographics
NPI:1053689968
Name:COLE, KRISTIE (RN)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28201 MARGUERITE PKWY
Mailing Address - Street 2:#13
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3719
Mailing Address - Country:US
Mailing Address - Phone:949-364-3928
Mailing Address - Fax:949-364-2297
Practice Address - Street 1:28201 MARGUERITE PKWY
Practice Address - Street 2:#13
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3719
Practice Address - Country:US
Practice Address - Phone:949-364-3928
Practice Address - Fax:949-364-2297
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA732011163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0150193OtherMEDI-CAL