Healthcare Provider Details

I. General information

NPI: 1407353519
Provider Name (Legal Business Name): KIRSTEN KATHLEEN RYDBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE VETERAN DRIVE
MINNEAPOLIS MN
55417
US

IV. Provider business mailing address

263 JOHNSON PKWY
SAINT PAUL MN
55106-6409
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4335
  • Fax:
Mailing address:
  • Phone: 651-307-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2096313
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: