Provider Demographics
NPI:1821007600
Name:HODSDON, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HODSDON
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 1:525 PORTLAND AVE
Mailing Address - Street 2:MC: 952
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-348-3033
Mailing Address - Fax:612-348-7818
Practice Address - Street 1:1213 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-872-8086
Practice Address - Fax:612-872-8547
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 099268-4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN742680100OtherMEDICAL ASSISTANCE
MN0107816OtherMEDICA
MN49G79HOOtherBLUE CROSS BLUE SHIELD
MN6982979OtherEVERCARE
MNHP34129OtherHEALTHPARTNERS
MN742680100OtherMEDICAL ASSISTANCE
MNP50671Medicare UPIN