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Jan Daniels Kristenson
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NPI Number Detailed Information
Provider Information:
| Name: | Jan Daniels Kristenson |
| Gender: | F |
| Provider License Number If Given: | 5138 |
NPI Information:
| NPI: | 1063411577 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 7/18/2005 |
| Last Update Date: | 7/8/2007 |
Provider Business Mailing Address:
| Address: | 200 4TH AVE W GOVERNMENT CENTER RM 300 Shakopee, MN 55379 |
| Phone Number: | |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | 200 4TH AVE W GOVERNMENT CENTER RM 300 Shakopee, MN 55379 |
| Phone Number: | 9524968504 |
| Fax Number: |
Provider Taxonomy:
| Primary: | 104100000X |
| Secondary (if any): | |
| State: | MN |
