Healthcare Provider Details

I. General information

NPI: 1447326285
Provider Name (Legal Business Name): KRISTA KAY MCMAHON CES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA BILLHAM

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

12798 88TH PL N
MAPLE GROVE MN
55369-9110
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: