Provider Demographics
NPI:1821237298
Name:PAUL-GATYAS, KRISTIN L (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:PAUL-GATYAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:715 2ND AVE S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7782
Practice Address - Country:US
Practice Address - Phone:952-428-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001333367A00000X
MNCNM 0184367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00590390Medicaid
NY00590390Medicaid