Healthcare Provider Details

I. General information

NPI: 1003128380
Provider Name (Legal Business Name): KRISTI L WENTWORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ELM ST SUITE 1200
ALEXANDRIA MN
56308-1760
US

IV. Provider business mailing address

725 ELM ST SUITE 1200
ALEXANDRIA MN
56308-1760
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-6018
  • Fax: 320-763-4127
Mailing address:
  • Phone: 320-763-6018
  • Fax: 320-763-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR 121580-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: