Healthcare Provider Details

I. General information

NPI: 1447358031
Provider Name (Legal Business Name): RACHEL LYNN KJELSBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SMITH AVE N SUITE 400
SAINT PAUL MN
55102-2534
US

IV. Provider business mailing address

3472 CHERRY LN UNIT A
WOODBURY MN
55129-7711
US

V. Phone/Fax

Practice location:
  • Phone: 651-726-2767
  • Fax:
Mailing address:
  • Phone: 651-337-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR153915-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: