Provider Demographics
NPI:1285406371
Name:KEENER, KIRSI ELIZABETH
Entity type:Individual
Prefix:
First Name:KIRSI
Middle Name:ELIZABETH
Last Name:KEENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIRSI
Other - Middle Name:ELIZABETH
Other - Last Name:HOSELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24990 96TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-9547
Mailing Address - Country:US
Mailing Address - Phone:612-239-9634
Mailing Address - Fax:
Practice Address - Street 1:720 WASHINGTON AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2924
Practice Address - Country:US
Practice Address - Phone:612-884-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily