Healthcare Provider Details

I. General information

NPI: 1578623005
Provider Name (Legal Business Name): KRISTINA EIR CATRINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA EIR TRIMBLE

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6246
  • Fax: 612-813-6358
Mailing address:
  • Phone: 612-813-6246
  • Fax: 612-813-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number105889
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: