Healthcare Provider Details

I. General information

NPI: 1013987957
Provider Name (Legal Business Name): KRISTINE M ALSWAGER WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 8TH ST
MINNEAPOLIS MN
55402
US

IV. Provider business mailing address

4206 30TH AVE S
MINNEAPOLIS MN
55406-3132
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-4822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR142075-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: