Healthcare Provider Details

I. General information

NPI: 1275928368
Provider Name (Legal Business Name): KRISTA GERMAIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTA STEWART APRN

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BROADWAY ST NE STE 120
MINNEAPOLIS MN
55413-2196
US

IV. Provider business mailing address

PO BOX 14909
MINNEAPOLIS MN
55414-0909
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1145
  • Fax: 612-870-5491
Mailing address:
  • Phone: 612-871-1145
  • Fax: 612-870-5491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP3825
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: