Provider Demographics
NPI:1215230354
Name:BAUMGARTNER, KENDALL BIALLAS (CPNP-AC)
Entity type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:BIALLAS
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:CPNP-AC
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Mailing Address - Street 1:2530 CHICAGO AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4387
Mailing Address - Country:US
Mailing Address - Phone:612-813-3300
Mailing Address - Fax:612-813-3349
Practice Address - Street 1:2530 CHICAGO AVE STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4387
Practice Address - Country:US
Practice Address - Phone:612-813-3300
Practice Address - Fax:612-813-3349
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3872363LP0200X, 363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics