Basic Information
| Provider Information | |||||||||
| NPI: | 1639433857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BJORNGJELD | ||||||||
| FirstName: | KRISTAL | ||||||||
| MiddleName: | LEA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIVERA | ||||||||
| OtherFirstName: | KRISTAL | ||||||||
| OtherMiddleName: | LEA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 246 MAIN ST S | ||||||||
| Address2: | PRAIRIE RIVER HOMECARE | ||||||||
| City: | HUTCHINSON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553502587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205875162 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 246 MAIN ST S | ||||||||
| Address2: | PRAIRIE RIVER HOMECARE | ||||||||
| City: | HUTCHINSON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553502587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205875162 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2012 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R 202655-8 | MN | Y | Nursing Service Providers | Registered Nurse |
No ID Information.