Provider Demographics
NPI:1003313719
Name:KROGSTAD, KIMBERLY DOWNS
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DOWNS
Last Name:KROGSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3935
Mailing Address - Country:US
Mailing Address - Phone:701-306-8183
Mailing Address - Fax:
Practice Address - Street 1:3601 12TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-8100
Practice Address - Country:US
Practice Address - Phone:218-287-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR44110163W00000X
MN50044163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse