Provider Demographics
NPI:1447629712
Name:BAHNSEN, KRISTA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:BAHNSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8475 HENNEPIN WAY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55052-5002
Mailing Address - Country:US
Mailing Address - Phone:507-210-9052
Mailing Address - Fax:
Practice Address - Street 1:2480 S COUNTY ROAD 45
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5113
Practice Address - Country:US
Practice Address - Phone:612-454-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0661795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse