Healthcare Provider Details

I. General information

NPI: 1821007600
Provider Name (Legal Business Name): KRISTEN HODSDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E FRANKLIN AVE
MINNEAPOLIS MN
55404
US

IV. Provider business mailing address

525 PORTLAND AVE MC: 952
MINNEAPOLIS MN
55415-1533
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-8086
  • Fax: 612-872-8547
Mailing address:
  • Phone: 612-348-3033
  • Fax: 612-348-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 099268-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: