Healthcare Provider Details

I. General information

NPI: 1497026009
Provider Name (Legal Business Name): KRISTINA ANNE KJOS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LABREE AVE SOUTH
THIEF RIVER FALLS MN
56701-2819
US

IV. Provider business mailing address

120 LABREE AVE SOUTH
THIEF RIVER FALLS MN
56701-2819
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-4240
  • Fax:
Mailing address:
  • Phone: 218-681-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: