Healthcare Provider Details

I. General information

NPI: 1558649913
Provider Name (Legal Business Name): KRAINA SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 SUMTER AVE N
CRYSTAL MN
55428-3312
US

IV. Provider business mailing address

5606 SUMTER AVE N
CRYSTAL MN
55428-3312
US

V. Phone/Fax

Practice location:
  • Phone: 612-521-1619
  • Fax: 763-219-8482
Mailing address:
  • Phone: 612-521-1619
  • Fax: 763-219-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DIANA HIJAH BAKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 612-251-1619