Provider Demographics
NPI:1598358491
Name:KLEINOW, KRISTINA E (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:E
Last Name:KLEINOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S DELL DR
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5257
Mailing Address - Country:US
Mailing Address - Phone:612-363-4634
Mailing Address - Fax:
Practice Address - Street 1:383 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327-7971
Practice Address - Country:US
Practice Address - Phone:406-346-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT91995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical