Joelyn Marie Kloncz
Individual provider Active NPI Contractor · Clear Lake, MN
NPI 1093856239 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1093856239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 1044577-2-AFC (MN)
- Practice address
- 9839 54TH St
Clear Lake, MN 55319-9556 - Phone
- (320) 743-5495
- NPI assigned
- Feb 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1044577-2-AFC | MN | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 1044577-2-AFC | MN | Yes |
Addresses
Primary practice location
9839 54TH St
Clear Lake, MN 55319-9556
Mailing address
9839 54TH St
Clear Lake, MN 55319-9556
Phone (320) 743-5495
Other providers in Clear Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.