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NPI Code Detail

MEDICARE: TINA KRETSCH

MEDICARE: TINA KRETSCH
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
1246ZC0007XSurgical Assistant113301MN

General Provider Information

NPI Number : 1932635547
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA KRETSCH
Provider Business Mailing Address
First Line : 17 EXCHANGE ST W STE 622
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-1225
Country : US
Telephone Number : 651-227-9141
Fax Number : 651-265-6772
Provider Business Practice Location Address
First Line : 17 EXCHANGE ST W STE 622
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-1225
Country : US
Telephone Number : 651-227-9141
Fax Number : 651-265-6772
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2017
Last Update Date : 05/03/2017

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