Healthcare Provider Details

I. General information

NPI: 1053581348
Provider Name (Legal Business Name): KRISTINA FARRAH SCOTT-MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA FARRAH SCOTT R. N.

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 8TH ST SE APT 321
MINNEAPOLIS MN
55414-1255
US

IV. Provider business mailing address

333 8TH ST SE APT 321
MINNEAPOLIS MN
55414-1255
US

V. Phone/Fax

Practice location:
  • Phone: 651-328-1823
  • Fax:
Mailing address:
  • Phone: 651-328-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: