Provider Demographics
NPI:1891589602
Name:KINDELIN, KRYSTAL DAWN
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DAWN
Last Name:KINDELIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 MCKENZIE DR SE APT 208
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-6241
Mailing Address - Country:US
Mailing Address - Phone:701-415-9834
Mailing Address - Fax:
Practice Address - Street 1:4250 MCKENZIE DR SE APT 208
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-6241
Practice Address - Country:US
Practice Address - Phone:701-415-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND207PH0002X207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine