Individual
STANLEY ANSEL KRISTIANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-3013
Mailing address
PO BOX 38, CORYDON, IN 47112-0038
(812) 738-4251
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209027161
IL
367500000X
Certified Registered Nurse Anesthetist
3006664
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
237042323
COMMERCIAL
IN
Enumeration date
01/08/2007
Last updated
05/10/2023
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