Healthcare Provider Details

I. General information

NPI: 1326717455
Provider Name (Legal Business Name): MRS. JAIME MARY KRUPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5919 230TH ST.
SAINT CLOUD MN
56301
US

IV. Provider business mailing address

5919 230TH STREET.
SAINT CLOUD MN
56301
US

V. Phone/Fax

Practice location:
  • Phone: 320-282-8178
  • Fax:
Mailing address:
  • Phone: 320-282-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: