Active NPI
Kristine Ann Michaelson, COTA/L
- Skilled Nursing Facility
- Hermantown, MN
National Provider Identifier
1447695002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 200447
- Practice address
- 5731 Jamesbard Rd
Hermantown, MN 55811-3640 - Phone
- (218) 729-1656
- NPI assigned
- May 8, 2013
- 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 |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 200447 | MN | Primary |
Addresses
Primary practice location
5731 Jamesbard Rd
Hermantown, MN 55811-3640
Mailing address
5731 Jamesbard Rd
Hermantown, MN 55811-3640
Phone (218) 729-1656
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 |
|---|---|---|---|
| 200447 | MN | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367971200000",
"number": "1447695002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5731 JAMESBARD RD",
"city": "HERMANTOWN",
"state": "MN",
"postal_code": "558113640",
"telephone_number": "218-729-1656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5731 JAMESBARD RD",
"city": "HERMANTOWN",
"state": "MN",
"postal_code": "558113640",
"telephone_number": "218-729-1656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHAELSON",
"first_name": "KRISTINE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-08",
"last_updated": "2013-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MN",
"license": "200447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermantown, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.