Healthcare Provider Details

I. General information

NPI: 1124819263
Provider Name (Legal Business Name): KENDRA KREMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 4TH AVE NE UNIT 19
DEVILS LAKE ND
58301-2400
US

IV. Provider business mailing address

524 4TH AVE NE UNIT 19
DEVILS LAKE ND
58301-2400
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-7055
  • Fax:
Mailing address:
  • Phone: 701-477-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: