Basic Information
| Provider Information | |||||||||
| NPI: | 1659047520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KITHINJI | ||||||||
| FirstName: | STELLA | ||||||||
| MiddleName: | KANANA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KITHINJI | ||||||||
| OtherFirstName: | STELLA | ||||||||
| OtherMiddleName: | KANANA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSN, APRN, NP-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7115 148TH LN NW | ||||||||
| Address2: | |||||||||
| City: | RAMSEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553034655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632184985 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7231 SUNWOOD DR NW | ||||||||
| Address2: | |||||||||
| City: | RAMSEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553035190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632360000 | ||||||||
| FaxNumber: | 7632360025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 8413 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LA2200X | 8413 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 00000000 | 01 | MN | N/A | OTHER |