Provider Demographics
NPI:1699752535
Name:HULTGREN, KRISTA JANE (GNP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:JANE
Last Name:HULTGREN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:JANE
Other - Last Name:NABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11401 HEATHER ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11401 HEATHER ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3453
Practice Address - Country:US
Practice Address - Phone:763-234-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2737363L00000X, 363LG0600X
MN03242493363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN108443700Medicaid
MN108443700Medicaid
MN108443700Medicaid