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General NPI Number Information
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NPI Number | 1811554629
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Entity Type | Organization
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Legal Business Name | KINDRED HEALTH, LLC.
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 6565 FRANCE AVE S STE 350
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City | EDINA
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State | MN
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Zip | 55435-2159
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Country | US
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Telephone | 952-999-4049
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Fax |
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Provider Business Mailing Address
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Address Line | 6565 FRANCE AVE S STE 350
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City | EDINA
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State | MN
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Zip | 55435-2159
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Country | US
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Telephone | 952-999-4049
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUZANNE MARY CARLSON-SHIMON
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Credential | FNP-BC
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Telephone | 651-491-4354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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