Individual provider Active NPI

Theresa Mae Krajewski, RN

  • Home Health Registered Nurse
  • Proctor, MN
National Provider Identifier
1437317609
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
R084464-8 Issued in MN
Practice address
1107 Bass Blvd
Proctor, MN 55810-2627
Phone
(218) 624-3830
Fax
(218) 624-3830
NPI assigned
May 23, 2008
Last updated
May 23, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X R084464-8 MN Primary

Addresses

Primary practice location

1107 Bass Blvd
Proctor, MN 55810-2627

Mailing address

1107 Bass Blvd
Proctor, MN 55810-2627
Phone (218) 624-3830

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R084464-8MNMDHome Health Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211500800000",
    "number": "1437317609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 BASS BLVD",
            "city": "PROCTOR",
            "state": "MN",
            "postal_code": "558102627",
            "telephone_number": "218-624-3830",
            "fax_number": "218-624-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 BASS BLVD",
            "city": "PROCTOR",
            "state": "MN",
            "postal_code": "558102627",
            "telephone_number": "218-624-3830",
            "fax_number": "218-624-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAJEWSKI",
        "first_name": "THERESA",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MN",
            "license": "R084464-8",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Proctor, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.