Healthcare Provider Details

I. General information

NPI: 1477392991
Provider Name (Legal Business Name): DANA KROMAR CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HIGHWAY 61 N STE 204
WHITE BEAR LAKE MN
55110-2752
US

IV. Provider business mailing address

4801 HIGHWAY 61 N STE 204
WHITE BEAR LAKE MN
55110-2752
US

V. Phone/Fax

Practice location:
  • Phone: 763-465-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11622
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: