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Individual

MARY KIDDER

Active
Sole proprietor

Provider details

NPI number
Gender
F

Contact information

Practice address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 222-1816
(651) 602-7517
Mailing address
2601 40TH AVE S, MINNEAPOLIS, MN 55406-1862

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
113653-3
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1200702
MEDICA
MN
01
127696
UCARE
MN
01
72Q60KI
BCBS
MN
01
HP30371
HEALTH PARTNERS
MS
01
NA9021022925
PREFERRED ONE
MN
Enumeration date
04/03/2006
Last updated
07/08/2007
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