Provider Demographics
NPI:1477912426
Name:IRWIN, KIJSA (RN AND CFCN)
Entity Type:Individual
Prefix:
First Name:KIJSA
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:RN AND CFCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2601
Mailing Address - Country:US
Mailing Address - Phone:218-260-3382
Mailing Address - Fax:
Practice Address - Street 1:920 SPRING LAKE RD
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2601
Practice Address - Country:US
Practice Address - Phone:218-260-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213374-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse