Provider Demographics
NPI:1023014446
Name:AMUNDSON, KRISTIN ELLEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ELLEN
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-0460
Mailing Address - Country:US
Mailing Address - Phone:320-239-3939
Mailing Address - Fax:320-239-2802
Practice Address - Street 1:501 POLER ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-0460
Practice Address - Country:US
Practice Address - Phone:320-239-3939
Practice Address - Fax:320-239-2802
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0559865164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse