1609144187 NPI number — KRISTEN M. BLENINGER-SUNDAR NP-C

Table of content: KRISTEN M. BLENINGER-SUNDAR NP-C (NPI 1609144187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609144187 NPI number — KRISTEN M. BLENINGER-SUNDAR NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLENINGER-SUNDAR
Provider First Name:
KRISTEN
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
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:
1609144187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5775 WAYZATA BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
SAINT LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-2687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-542-8553
Provider Business Mailing Address Fax Number:
952-513-6880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5775 WAYZATA BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
SAINT LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-2687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-835-9777
Provider Business Practice Location Address Fax Number:
952-835-9830
Provider Enumeration Date:
12/12/2011

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: 363LA2200X , with the licence number:  R 164279-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 2067 , 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)





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