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NPI Code Detail

MEDICARE: KRISTA JANE HULTGREN GNP

MEDICARE: KRISTA JANE HULTGREN GNP
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
1363L00000XNurse Practitioner2737MN
2363LG0600XGerontology Nurse Practitioner03242493MN
3363LG0600XGerontology Nurse Practitioner2737MN

Other Identifiers

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

General Provider Information

NPI Number : 1699752535
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA JANE HULTGREN GNP
Provider Business Mailing Address
First Line : 11401 HEATHER ST NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-3453
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5200 DOUGLAS DR N
Second Line :
City : CRYSTAL
State : MN
Zip : 55429-3104
Country : US
Telephone Number : 888-290-1209
Fax Number : 833-973-3527
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 07/23/2025

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