Healthcare Provider Details

I. General information

NPI: 1134195282
Provider Name (Legal Business Name): KARA LYNN LEWIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA LYNN KREMINSKI NP

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 NORTHDALE BLVD STE 10
ROGERS MN
55374-9612
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 763-488-4100
  • Fax:
Mailing address:
  • Phone: 763-488-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1413706
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1802
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: