Basic Information
| Provider Information | |||||||||
| NPI: | 1619597002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATRAS | ||||||||
| FirstName: | KRISTIN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14565 W WILSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6236959552 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9930 W INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850375902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238467558 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2020 | ||||||||
| LastUpdateDate: | 04/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 240700 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.