Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R163417-4 | MN |
NPI | 1174911127 |
---|---|
Provider Name | Kristin Ann Gjerset |
First Address | St Cloud, MN 56303-2735 |
Second Address | St Cloud, MN 56303-2735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2014 |
Last Update Date | 29/12/2014 |