Provider Demographics
NPI:1477701514
Name:OLNESS, KIRSTEN A
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:A
Last Name:OLNESS
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:320-203-2113
Practice Address - Street 1:2251 CONNECTICUT AVE S
Practice Address - Street 2:HP CENTRAL MN CLINICS
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2486
Practice Address - Country:US
Practice Address - Phone:320-253-5220
Practice Address - Fax:320-203-2113
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 165037-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500004906Medicare PIN