Individual
MISS KIERSTIN K CHURCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1040 W GRAND AVE, APT. 208, PORTERVILLE, CA 93257-1904
(207) 593-6496
Mailing address
1040 W GRAND AVE, APT. 208, PORTERVILLE, CA 93257-1904
(207) 593-6496
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 487393
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
487393
CA
367500000X
Certified Registered Nurse Anesthetist
R053337
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433004799
—
ME
Enumeration date
07/18/2006
Last updated
04/03/2013
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