Provider Demographics
NPI:1770360240
Name:JANDL, KRISTINE KAY
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KAY
Last Name:JANDL
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:MN
Mailing Address - Zip Code:56455-0001
Mailing Address - Country:US
Mailing Address - Phone:218-546-6242
Mailing Address - Fax:218-772-0326
Practice Address - Street 1:317 IRENE AVE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MN
Practice Address - Zip Code:56455-2612
Practice Address - Country:US
Practice Address - Phone:218-546-6242
Practice Address - Fax:218-772-0326
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1353345163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health