Provider Demographics
NPI:1578599536
Name:KREIN, BETH ANN (PAC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:KREIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 FRIBOURG CT
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-3705
Mailing Address - Country:US
Mailing Address - Phone:612-269-8660
Mailing Address - Fax:
Practice Address - Street 1:4729 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-2634
Practice Address - Country:US
Practice Address - Phone:952-974-3200
Practice Address - Fax:952-974-3201
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN550001000Medicaid
MN970002519Medicare ID - Type Unspecified
MN550001000Medicaid