Individual
MS. KRISTINA M IJOMAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2236 MARSHALL AVE, SAINT PAUL, MN 55104-5799
(651) 332-5963
(651) 659-0161
Mailing address
2236 MARSHALL AVE, SAINT PAUL, MN 55104-5799
(651) 332-5963
(651) 659-0161
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
R108963-5
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148313700
—
MN
01
—
868K1CA
BLUE CROSS BLUE SHEILD
MN
Enumeration date
10/30/2009
Last updated
10/30/2009
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