Provider Demographics
NPI:1962882696
Name:STEVENS, KRISTIN (NP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CARLSON PKWY
Mailing Address - Street 2:MAIL ROUTE CP340
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5359
Mailing Address - Country:US
Mailing Address - Phone:952-992-3581
Mailing Address - Fax:
Practice Address - Street 1:401 CARLSON PKWY
Practice Address - Street 2:MAIL ROUTE CP340
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5359
Practice Address - Country:US
Practice Address - Phone:952-992-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR185179-5363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner