Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F1014122 | MN |
NPI | 1063812436 |
---|---|
Provider Name | Kristen Medhanie |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Brooklyn Park, MN 55443-5500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2014 |
Last Update Date | 10/11/2020 |