Provider Demographics
NPI:1083904569
Name:KRISCH, ISABELLE MARIE HEIER (NP)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:MARIE HEIER
Last Name:KRISCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ISABELLE
Other - Middle Name:M
Other - Last Name:HEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2530 CHICAGO AVE # CSCG055
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4289
Mailing Address - Country:US
Mailing Address - Phone:612-813-6938
Mailing Address - Fax:612-813-6953
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:CSC 390
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-6938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 194191-9363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MNENROLLEDMedicaid