Provider Demographics
NPI:1043456544
Name:SETTERGREN, KIMBERLY MARIE (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:SETTERGREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:525 S LAKE AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2362
Mailing Address - Country:US
Mailing Address - Phone:218-740-1176
Mailing Address - Fax:
Practice Address - Street 1:525 S LAKE AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2362
Practice Address - Country:US
Practice Address - Phone:218-740-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 098647-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse