Provider Demographics
NPI:1497934699
Name:KREFT, GWEN (BSRT(R)(M)(CDT))
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:KREFT
Suffix:
Gender:F
Credentials:BSRT(R)(M)(CDT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 DOMINION ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1206
Mailing Address - Country:US
Mailing Address - Phone:701-221-5863
Mailing Address - Fax:
Practice Address - Street 1:3617 DOMINION ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1206
Practice Address - Country:US
Practice Address - Phone:701-221-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2737472471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography