Healthcare Provider Details

I. General information

NPI: 1588057939
Provider Name (Legal Business Name): KRISTINA THANH NGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17673 FAIR ISLE PATH
FARMINGTON MN
55024-8855
US

IV. Provider business mailing address

17673 FAIR ISLE PATH
FARMINGTON MN
55024-8855
US

V. Phone/Fax

Practice location:
  • Phone: 612-670-2909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR 225884-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: