Individual
KELLY KANTACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
360 COLBORNE ST, SAINT PAUL, MN 55102-3228
(651) 744-2290
Mailing address
360 COLBORNE ST, SAINT PAUL, MN 55102-3228
(651) 744-2290
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
1316971
MN
Other
Enumeration date
03/09/2026
Last updated
03/18/2026
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