Provider Demographics
NPI:1972589034
Name:LINDBLOM, KRISTEN ANN (FNP)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:ANN
Last Name:LINDBLOM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 LONDON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2422
Mailing Address - Country:US
Mailing Address - Phone:218-728-6160
Mailing Address - Fax:
Practice Address - Street 1:1420 LONDON RD STE 210
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2422
Practice Address - Country:US
Practice Address - Phone:218-728-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI142804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43980400Medicaid
MN419715100OtherMA
S33643Medicare UPIN
WI000609035Medicare ID - Type Unspecified