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General NPI Number Information
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NPI Number | 1760730980
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Entity Type | Individual
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Provider Name | KRISTEN EMILY LEWICKI NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 10705 TOWN SQUARE DR NE
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City | BLAINE
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State | MN
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Zip | 55449-8184
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Country | US
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Telephone | 763-236-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 2027 141ST AVE NE
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City | HAM LAKE
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State | MN
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Zip | 55304-6551
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Country | US
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Telephone | 651-338-4027
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F0712464
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3273
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License Number State | MN
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