MEDICARE: KRISTINE CACNIO RN

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	367500000X	Certified Registered Nurse Anesthetist	26NR18891100	NJ

General Provider Information

NPI Number	:	1922786003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE CACNIO RN

Provider Business Mailing Address
First Line	:	430 OXFORD ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58202-6092
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 OXFORD ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58202-6092
Country	:	US
Telephone Number	:	701-777-7417
Fax Number	:

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

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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