Healthcare Provider Details

I. General information

NPI: 1790557171
Provider Name (Legal Business Name): CHRISTINE MARIE KIEFFER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE MARIE JOHNSON

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E STE 101
ALEXANDRIA MN
56308-5274
US

IV. Provider business mailing address

1500 IRVING ST
ALEXANDRIA MN
56308-0046
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1144
  • Fax: 320-762-1935
Mailing address:
  • Phone: 320-335-6062
  • Fax: 320-763-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10940
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: