Provider Demographics
NPI:1376973958
Name:ANDERSON, KAITLIN WHA RAN (CNM)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:WHA RAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNM
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Other - Credentials:
Mailing Address - Street 1:3300 FREMONT AVE S
Mailing Address - Street 2:APT #201
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3581
Mailing Address - Country:US
Mailing Address - Phone:763-516-7081
Mailing Address - Fax:
Practice Address - Street 1:710 E 24TH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3840
Practice Address - Country:US
Practice Address - Phone:612-870-1334
Practice Address - Fax:612-871-0864
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 216381-9367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife