Provider Demographics
NPI:1003625997
Name:BAUER, KRISTA JANISZEWSKI (MSN, FNP-C, WCC, OMS)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:JANISZEWSKI
Last Name:BAUER
Suffix:
Gender:F
Credentials:MSN, FNP-C, WCC, OMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20333 N 19TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-9901
Mailing Address - Country:US
Mailing Address - Phone:480-707-9504
Mailing Address - Fax:
Practice Address - Street 1:20333 N 19TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-9901
Practice Address - Country:US
Practice Address - Phone:480-707-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN164452163W00000X
AZ318838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse