Provider Demographics
NPI:1689962714
Name:KUHNLYSAGE, KRSTINE ANN
Entity Type:Individual
Prefix:
First Name:KRSTINE
Middle Name:ANN
Last Name:KUHNLYSAGE
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 1:2000 CLIFF LAKE ROAD
Mailing Address - Street 2:T-0360
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 CLIFF LAKE ROAD
Practice Address - Street 2:T-0360
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2400
Practice Address - Country:US
Practice Address - Phone:651-688-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist