Individual
KRISTINE K DOMIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R138036-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041H1DO
MNBS #
MN
05
—
1134172034
—
MN
01
—
2003184
MEDICA #
MN
01
—
26506
NDBS #
MN
01
—
49119
AMERICA'S PPO/ARAZ #
MN
01
—
DA9031016140
PREFERRED ONE #
MN
01
—
HP42498
HEALTHPARTNERS #
MN
Enumeration date
05/19/2006
Last updated
07/13/2012
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