Provider Demographics
NPI:1487629531
Name:LOOP, KRISTA J (CFNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:J
Last Name:LOOP
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:J
Other - Last Name:DANNEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNP
Mailing Address - Street 1:3300 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2405
Mailing Address - Country:US
Mailing Address - Phone:612-588-9411
Mailing Address - Fax:612-588-8066
Practice Address - Street 1:3300 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2405
Practice Address - Country:US
Practice Address - Phone:612-588-9411
Practice Address - Fax:612-588-8066
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1675696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN912693700Medicaid
Q56636Medicare UPIN
MN912693700Medicaid