Individual
KRISTENE QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
524 E MCKINLEY AVE, MISHAWAKA, IN 46545-6285
(574) 256-2556
Mailing address
29580 COUNTY ROAD 6, ELKHART, IN 46514-9513
(574) 596-3258
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005344A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201282570
—
IN
Enumeration date
01/10/2015
Last updated
11/21/2016
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