Healthcare Provider Details

I. General information

NPI: 1558185850
Provider Name (Legal Business Name): KRISTIE ANN KINZELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 89TH AVE SE
COURTENAY ND
58426-9710
US

IV. Provider business mailing address

1661 89TH AVE SE
COURTENAY ND
58426-9710
US

V. Phone/Fax

Practice location:
  • Phone: 701-320-8742
  • Fax:
Mailing address:
  • Phone: 701-320-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR31472
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR31472
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR31472
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR31472
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: