Healthcare Provider Details

I. General information

NPI: 1437760659
Provider Name (Legal Business Name): KRISTIN MERTINS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRITIN STANGLER

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 PAQUIN ST E
WATERVILLE MN
56096-1532
US

IV. Provider business mailing address

404 PAQUIN ST E
WATERVILLE MN
56096-1532
US

V. Phone/Fax

Practice location:
  • Phone: 507-838-6838
  • Fax:
Mailing address:
  • Phone: 507-838-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2203627
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: