Provider Demographics
NPI:1881113546
Name:RISTAU, KARA SUE (FNP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:SUE
Last Name:RISTAU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43711 20TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:MN
Mailing Address - Zip Code:56027-2103
Mailing Address - Country:US
Mailing Address - Phone:507-848-1286
Mailing Address - Fax:
Practice Address - Street 1:717 S STATE ST STE 900
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4478
Practice Address - Country:US
Practice Address - Phone:072-384-9495
Practice Address - Fax:507-238-3377
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily