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Kristina Nicole Fairbanks

NPI Registration Record

Provider / OrganizationNPIDate Certified
KRISTINA NICOLE FAIRBANKS10337280432020-07-26
Entity TypeIndividual
Provider Name Kristina Nicole Fairbanks MS
Practice Office Address1308 N MAIN ST
CROWN POINT, IN US
Practice Office Telephone2196636353
Mailing Address8694 FOREST GLEN CT
SAINT JOHN, IN 463738424 US
Business Telephone6302173921
Contact Endpoints
Email [][email protected]Direct
HPT Codes
CodeLicense NoState
101YM0800X PRIMARY
OPI Codes

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