Individual
MRS. KRISTEN E. FLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
1540 FLORIDA AVE, MODESTO, CA 95350-4430
(209) 238-4800
(209) 238-4890
Mailing address
1910 CUSTOMER CARE WAY, ATWATER, CA 95301-5167
(209) 384-6493
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN95078988
CA
363LG0600X
Gerontology Nurse Practitioner
Primary
NP95007308
CA
Other
Enumeration date
08/21/2017
Last updated
09/15/2017
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