Healthcare Provider Details

I. General information

NPI: 1467699728
Provider Name (Legal Business Name): KRISTA L NESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426
US

IV. Provider business mailing address

6465 WAYZATA BLVD SUITE 210
ST LOUIS PARK MN
55426
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 169712-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: