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Individual

KRISTA K. SIDELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1718 E 4TH ST, SUITE 105, CHARLOTTE, NC 28204-3261
(704) 384-7292
(704) 384-8880
Mailing address
PO BOX 601529, CHARLOTTE, NC 28260-1529
(704) 384-7292
(704) 384-8880

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
900366
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7005566
NC
Enumeration date
07/26/2005
Last updated
02/07/2013
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