Provider Demographics
NPI:1619963881
Name:KROENLEIN, KRISTI S (MS FNP APN BC FNP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:S
Last Name:KROENLEIN
Suffix:
Gender:F
Credentials:MS FNP APN BC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554
Mailing Address - Country:US
Mailing Address - Phone:309-478-1700
Mailing Address - Fax:309-478-1701
Practice Address - Street 1:2401 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3905
Practice Address - Country:US
Practice Address - Phone:309-478-1700
Practice Address - Fax:309-478-1701
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q48213Medicare UPIN
ILK19298Medicare ID - Type Unspecified