Provider Demographics
NPI:1316592447
Name:ZANTOW, KRISTINE (LSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:ZANTOW
Suffix:
Gender:F
Credentials:LSW
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 279
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:ND
Mailing Address - Zip Code:58436-0279
Mailing Address - Country:US
Mailing Address - Phone:701-349-3271
Mailing Address - Fax:701-349-3277
Practice Address - Street 1:205 15TH ST N
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:ND
Practice Address - Zip Code:58436-7600
Practice Address - Country:US
Practice Address - Phone:701-349-3271
Practice Address - Fax:701-349-3277
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No104100000XBehavioral Health & Social Service ProvidersSocial Worker