Provider Demographics
NPI:1356308753
Name:KREITZER, KATHLEEN MARIAN (RN CNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIAN
Last Name:KREITZER
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 PENN AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411
Mailing Address - Country:US
Mailing Address - Phone:612-543-2660
Mailing Address - Fax:612-677-6495
Practice Address - Street 1:1313 PENN AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:612-543-2660
Practice Address - Fax:612-677-6495
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1302011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN950518100Medicaid
500001649Medicare ID - Type Unspecified
P31961Medicare UPIN