Provider Demographics
NPI:1558185850
Name:KINZELL, KRISTIE ANN (RN)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:ANN
Last Name:KINZELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 89TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COURTENAY
Mailing Address - State:ND
Mailing Address - Zip Code:58426-9710
Mailing Address - Country:US
Mailing Address - Phone:701-320-8742
Mailing Address - Fax:
Practice Address - Street 1:1661 89TH AVE SE
Practice Address - Street 2:
Practice Address - City:COURTENAY
Practice Address - State:ND
Practice Address - Zip Code:58426-9710
Practice Address - Country:US
Practice Address - Phone:701-320-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31472163WC0400X, 163WP0808X, 163W00000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)