Provider Demographics
NPI:1376848911
Name:DICKINSON-ANDERSON, KRISTA A
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:A
Last Name:DICKINSON-ANDERSON
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 1:104 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55052-2003
Mailing Address - Country:US
Mailing Address - Phone:507-330-8383
Mailing Address - Fax:
Practice Address - Street 1:328 HERITAGE PL STE A
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5251
Practice Address - Country:US
Practice Address - Phone:507-332-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist