Provider Demographics
NPI:1104163369
Name:SKOGLUND, KRISTA MARIE (PA)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:MARIE
Last Name:SKOGLUND
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Gender:F
Credentials:PA
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Mailing Address - Street 1:11850 BLACKFOOT ST NW
Mailing Address - Street 2:SUITE 490
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2578
Mailing Address - Country:US
Mailing Address - Phone:763-427-1137
Mailing Address - Fax:763-427-4643
Practice Address - Street 1:11850 BLACKFOOT ST NW
Practice Address - Street 2:SUITE 490
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2578
Practice Address - Country:US
Practice Address - Phone:763-427-1137
Practice Address - Fax:763-427-4643
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2025-01-08
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Provider Licenses
StateLicense IDTaxonomies
MN11298363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical