Individual
MARK OLIVER KRAGENBRING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R1279678
MN
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
R1279678
MN
Other
Enumeration date
10/07/2010
Last updated
10/07/2010
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