=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114205978
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGIA RAE KREIN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2011
-----------------------------------------------------
Last Update Date | 07/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 MAIN ST S MCHS MINOT / HEARTLAND CARE PARTNERS
-----------------------------------------------------
City | MINOT
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58701-4499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-375-5495
-----------------------------------------------------
Fax | 800-564-5952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14210 72ND AVE NW
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58722-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | R23732
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------