Provider Demographics
NPI:1376899948
Name:NOACK, KRISTINE LYNN
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LYNN
Last Name:NOACK
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 1:12762 300TH ST
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-2854
Mailing Address - Country:US
Mailing Address - Phone:320-493-8444
Mailing Address - Fax:
Practice Address - Street 1:401 DEWEY ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8406
Practice Address - Country:US
Practice Address - Phone:320-968-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist