Provider Demographics
NPI:1063812436
Name:MEDHANIE, KRISTEN (RN, CNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MEDHANIE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:NEIGEBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:9300 NOBLE PKWY N
Practice Address - Street 2:ALLINA MEDICAL CLINIC- BROOKLYN PARK
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-5500
Practice Address - Country:US
Practice Address - Phone:763-236-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR190231-4163W00000X
MNF1014122363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse