Healthcare Provider Details

I. General information

NPI: 1629376926
Provider Name (Legal Business Name): KRISTY CAROL WAMSHER CRTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E NICOLLET BLVD
BURNSVILLE MN
55337-5714
US

IV. Provider business mailing address

17312 IPSWICH WAY
LAKEVILLE MN
55044-9698
US

V. Phone/Fax

Practice location:
  • Phone: 952-892-2495
  • Fax:
Mailing address:
  • Phone: 952-898-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2193
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2278E0002X
TaxonomyEmergency Care Certified Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: