MEDICARE: BETH ANN KREIN PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9480	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578599536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ANN KREIN PAC

Provider Business Mailing Address
First Line	:	878 FRIBOURG CT
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-3705
Country	:	US
Telephone Number	:	612-269-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	4729 COUNTY ROAD 101
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-2634
Country	:	US
Telephone Number	:	952-974-3200
Fax Number	:	952-974-3201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/11/2021

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Directions to “ BETH ANN KREIN PAC” Practice Location

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