1275829392 NPI number — MRS. KRISTINA SUZANNE WILLIAMS RPH

Table of content: MRS. KRISTINA SUZANNE WILLIAMS RPH (NPI 1275829392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275829392 NPI number — MRS. KRISTINA SUZANNE WILLIAMS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
KRISTINA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275829392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15300 GROVE CIR N
Provider Second Line Business Mailing Address:
T-2193
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55369-4469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-447-2507
Provider Business Mailing Address Fax Number:
763-447-2517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11330 FOUNTAINS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-494-8059
Provider Business Practice Location Address Fax Number:
763-494-8056
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  116606 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com