Healthcare Provider Details

I. General information

NPI: 1568805943
Provider Name (Legal Business Name): KRISTEN LEE ANDERSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 3RD ST ESSENTIA HEALTH DULUTH CLINIC
DULUTH MN
55805-1951
US

IV. Provider business mailing address

400 E 3RD ST ESSENTIA HEALTH DULUTH CLINIC
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR183613-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR183613-4
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR183613-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: