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NPI Code Detail

MEDICARE: ANNA KINNEBERG

MEDICARE:   ANNA  KINNEBERG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist121338MN

General Provider Information

NPI Number : 1427656412
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA KINNEBERG
Provider Business Mailing Address
First Line : 1496 68TH AVE SOUTH
Second Line :
City : FARGO
State : ND
Zip : 58104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1583 HIGHWAY 10 W
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-2232
Country : US
Telephone Number : 218-847-7225
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2020
Last Update Date : 01/11/2024

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Directions to “ ANNA KINNEBERG ” Practice Location

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