Individual
KRISTIN ELISABETH DEARRUDA WHARTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
513 5TH AVE W, GRAND MARAIS, MN 55604-3017
(183) 872-3302
Mailing address
513 5TH AVE W, GRAND MARAIS, MN 55604-3017
(183) 872-3302
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7075
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11185596
INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS
—
01
—
16274
MINNESOTA BOARD OF NURSING- PUBLIC HEALTH NURSE
MN
01
—
169220-0
MINNESOTA BOARD OF NURSING
MN
01
—
7075
MINNESOTA BOARD OF NURSING- APRN LICENSE
MN
01
—
F09191840
AMERICAN ACADEMY OF NURSE PRACTITIONERS
—
Enumeration date
11/20/2019
Last updated
06/13/2024
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