Healthcare Provider Details

I. General information

NPI: 1184053233
Provider Name (Legal Business Name): KRISTIN GREATHOUSE CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

700 CHILDRENS DR CARDIOTHORACIC INTENSIVE CARE UNIT
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7838
  • Fax: 612-273-3203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberCOA.15230-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: