Healthcare Provider Details

I. General information

NPI: 1962135913
Provider Name (Legal Business Name): DYLAN JOSEPH KRATOCHVIL CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

IV. Provider business mailing address

150 3RD AVE S
MINNEAPOLIS MN
55401-2557
US

V. Phone/Fax

Practice location:
  • Phone: 507-537-9393
  • Fax:
Mailing address:
  • Phone: 507-591-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9782
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR050448
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: