Provider Demographics
NPI:1821404021
Name:NIETFELD, KRISTEN (AT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:NIETFELD
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 CHASEWOOD PKWY APT 123
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4376
Mailing Address - Country:US
Mailing Address - Phone:320-237-7801
Mailing Address - Fax:
Practice Address - Street 1:6125 CHASEWOOD PKWY APT 123
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4376
Practice Address - Country:US
Practice Address - Phone:320-237-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer