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General NPI Number Information
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NPI Number | 1003313719
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Entity Type | Individual
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Provider Name | KIMBERLY DOWNS KROGSTAD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 3601 12TH AVE S
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City | MOORHEAD
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State | MN
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Zip | 56560-8100
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Country | US
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Telephone | 218-287-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1249 4TH ST NW
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City | WEST FARGO
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State | ND
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Zip | 58078-3935
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Country | US
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Telephone | 701-306-8183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R44110
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 50044
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License Number State | MN
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