Provider Demographics
NPI:1366926685
Name:GREENGARD, KRISTINA ANDREA
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANDREA
Last Name:GREENGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 E WATSON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3346
Mailing Address - Country:US
Mailing Address - Phone:480-770-6211
Mailing Address - Fax:480-409-8490
Practice Address - Street 1:2302 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1301
Practice Address - Country:US
Practice Address - Phone:480-770-6211
Practice Address - Fax:480-409-8490
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1723175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath