Individual
IMO I KALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2251 CONNECTICUT AVENUE S, HP CENTRAL MN CLINICS, SARTELL, MN 56377-2486
(320) 253-5220
(320) 203-2113
Mailing address
8170 33RD AVE S, MS21110Q, FREEPORT, MN 55425-4516
(952) 883-5375
(320) 203-2113
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R118728-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177515400
—
MN
Enumeration date
04/06/2007
Last updated
12/20/2011
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