Basic Information
| Provider Information | |||||||||
| NPI: | 1316273204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANCOCK | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | CHASE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14000 FAIRVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14000 FAIRVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2009 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN60023945 | WA | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | AP60116836 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | R2068312 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.