Individual
KRISTY JORDAN LICHTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
225 SMITH AVE N, STE 200, ST PAUL, MN 55102-2697
(651) 241-5111
(651) 241-5512
Mailing address
2925 CHICAGO AVENUE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12632
MN
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
01/15/2018
Last updated
12/14/2023
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