Active NPI
Anna Kinneberg
- Pharmacist
- Detroit Lakes, MN
National Provider Identifier
1427656412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 121338
- Practice address
- 1583 Highway 10 W
Detroit Lakes, MN 56501-2232 - Phone
- (218) 847-7225
- NPI assigned
- Oct 13, 2020
- Last updated
- Jan 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 121338 | MN | Primary |
Addresses
Primary practice location
1583 Highway 10 W
Detroit Lakes, MN 56501-2232
Mailing address
1496 68TH Ave South
Fargo, ND 58104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121338 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704931200000",
"number": "1427656412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1496 68TH AVE SOUTH",
"city": "FARGO",
"state": "ND",
"postal_code": "58104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1583 HIGHWAY 10 W",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565012232",
"telephone_number": "218-847-7225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNEBERG",
"first_name": "ANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-13",
"last_updated": "2024-01-11",
"certification_date": "2024-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "121338",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.