Individual
JANELLE ELIZABETH KIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2104 NORTHDALE BLVD NW, SUITE 220, COON RAPIDS, MN 55433-3028
(763) 537-6000
(763) 537-6666
Mailing address
2104 NORTHDALE BLVD NW, SUITE 220, COON RAPIDS, MN 55433-3028
(763) 537-6000
(763) 537-6666
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209.006895
IL
363LF0000X
Family Nurse Practitioner
Primary
CNP 3902
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209006895
APN LICENSE
IL
01
—
CNP 3902
MINNESOTA NP LICENSE
MN
Enumeration date
01/02/2008
Last updated
07/02/2015
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