Provider Demographics
NPI:1295967859
Name:ZEMBRODT, KRISTEN MICHELLE (MED)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:ZEMBRODT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W 5TH ST
Mailing Address - Street 2:514
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1823
Mailing Address - Country:US
Mailing Address - Phone:859-760-8747
Mailing Address - Fax:
Practice Address - Street 1:520 W 5TH ST
Practice Address - Street 2:514
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1823
Practice Address - Country:US
Practice Address - Phone:859-760-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000060090174400000X
NC88083174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist