Healthcare Provider Details

I. General information

NPI: 1528043171
Provider Name (Legal Business Name): KATHRYN I KRESLINS G.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 WESTGATE DR SUITE 100
SAINT PAUL MN
55114-1065
US

IV. Provider business mailing address

3433 BROADWAY ST NE STE 300
MINNEAPOLIS MN
55413-1761
US

V. Phone/Fax

Practice location:
  • Phone: 612-262-3918
  • Fax:
Mailing address:
  • Phone: 763-587-7737
  • Fax: 763-587-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR144356-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: