Wake, Kristine M
Wake, Kristine M is an individual health care provider with primary practice located at 750 Round Valley Dr Ste 102 , Park City UT 84060-7549. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Wake, Kristine M can be contacted via phone (435) 655-0926.Contact Information
Primary practice address
750 Round Valley Dr Ste 102
Park City UT 84060-7549
Phone: (435) 655-0926
Fax: (435) 649-3748
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 41975 | Wisconsin |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 12807093-1205 | Utah |
Profile Details
| NPI number | 1932216975 |
|---|---|
| LBN Legal business name | Wake, Kristine M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2006 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932216975 | NPPES |
| Wisconsin | MEDICAID | 1932216975 |
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