Provider Demographics
NPI:1598142333
Name:KITTELSON, NIKKI JO
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:JO
Last Name:KITTELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:MN
Mailing Address - Zip Code:56218
Mailing Address - Country:US
Mailing Address - Phone:320-226-5166
Mailing Address - Fax:
Practice Address - Street 1:437 3RD ST
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:MN
Practice Address - Zip Code:56218-0134
Practice Address - Country:US
Practice Address - Phone:320-226-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 198265-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse