Healthcare Provider Details

I. General information

NPI: 1336466614
Provider Name (Legal Business Name): KRISTIN ZACHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 NABER AVE NE
SAINT MICHAEL MN
55376-9424
US

IV. Provider business mailing address

5080 NABER AVE NE
SAINT MICHAEL MN
55376-9424
US

V. Phone/Fax

Practice location:
  • Phone: 763-497-2389
  • Fax:
Mailing address:
  • Phone: 763-497-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number1051625-3-AFC
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: