Healthcare Provider Details

I. General information

NPI: 1891195459
Provider Name (Legal Business Name): KRISTEN ANDERSON AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2014
Last Update Date: 09/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 2ND ST NE APT 110
HOPKINS MN
55343-8342
US

IV. Provider business mailing address

1015 2ND ST NE APT 110
HOPKINS MN
55343-8342
US

V. Phone/Fax

Practice location:
  • Phone: 218-256-1671
  • Fax:
Mailing address:
  • Phone: 218-256-1671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR 202784-5
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR 202784-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: