Individual
KRISTELLE NICOLE WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1200 E JOPPA RD, BALTIMORE, MD 21286-5810
(443) 798-7077
Mailing address
402 MUSCOVY CT, HAVRE DE GRACE, MD 21078-4227
(410) 652-8555
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R201059
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R201059
LICENSE NUMBER
MD
Enumeration date
04/12/2021
Last updated
04/15/2021
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