Healthcare Provider Details

I. General information

NPI: 1437317609
Provider Name (Legal Business Name): THERESA MAE KRAJEWSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 BASS BLVD
PROCTOR MN
55810-2627
US

IV. Provider business mailing address

1107 BASS BLVD
PROCTOR MN
55810-2627
US

V. Phone/Fax

Practice location:
  • Phone: 218-624-3830
  • Fax: 218-624-3830
Mailing address:
  • Phone: 218-624-3830
  • Fax: 218-624-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR084464-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: