Provider Demographics
NPI:1639440688
Name:KRACHER, JOAN CAROL
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CAROL
Last Name:KRACHER
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 1:13710 60TH PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3519
Mailing Address - Country:US
Mailing Address - Phone:763-670-3237
Mailing Address - Fax:
Practice Address - Street 1:13710 60TH PL N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3519
Practice Address - Country:US
Practice Address - Phone:763-670-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications