Provider Demographics
NPI:1417698846
Name:MCCONNELL, KRISTEN LYNN I (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LYNN
Last Name:MCCONNELL
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15709 HEYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7150
Mailing Address - Country:US
Mailing Address - Phone:952-200-1232
Mailing Address - Fax:
Practice Address - Street 1:1757 158TH AVE NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-2796
Practice Address - Country:US
Practice Address - Phone:763-257-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN610461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse