Healthcare Provider Details

I. General information

NPI: 1972929503
Provider Name (Legal Business Name): KELLY RHEINGANS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 GOLDEN VALLEY RD COURAGE KENNY ADVANCED PRIMARY CARE CLINIC
GOLDEN VALLEY MN
55422-4249
US

IV. Provider business mailing address

3915 GOLDEN VALLEY RD COURAGE KENNY ADVANCED PRIMARY CARE CLINIC
GOLDEN VALLEY MN
55422-4249
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-0453
  • Fax: 763-520-0869
Mailing address:
  • Phone: 763-520-0453
  • Fax: 763-520-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR 196804-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: