=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194130245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTLE ANN TROYER DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2014
-----------------------------------------------------
Last Update Date | 11/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7600 FRANCE AVE S STE 1100
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-5936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-964-6681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 888 WORCESTER ST STE 130
-----------------------------------------------------
City | WELLESLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02482-3744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-964-6681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 111925
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------