Healthcare Provider Details

I. General information

NPI: 1710813456
Provider Name (Legal Business Name): KYLIE THEDENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E 26TH ST
MINNEAPOLIS MN
55404-4514
US

IV. Provider business mailing address

107 13TH AVE NE APT 310
MINNEAPOLIS MN
55413-3136
US

V. Phone/Fax

Practice location:
  • Phone: 612-775-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number2518259
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: