Provider Demographics
NPI:1447586136
Name:IJOMAH, KRISTINA M (RN)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:M
Last Name:IJOMAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:2236 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5799
Mailing Address - Country:US
Mailing Address - Phone:651-332-5963
Mailing Address - Fax:651-659-0161
Practice Address - Street 1:2236 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5799
Practice Address - Country:US
Practice Address - Phone:651-332-5963
Practice Address - Fax:651-659-0161
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR108963-5163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN868K1CAOtherBLUE CROSS BLUE SHEILD
MN148313700Medicaid