| Kristin Deneille Hazeman, DNP, APRN, CNM | |
| 
					1001 Hart Blvd Ste 100, Monticello, MN 55362-8929  | |
| (763) 295-2921 | |
| (763) 581-9090 | 
| Full Name | Kristin Deneille Hazeman | 
|---|---|
| Gender | Female | 
| Speciality | Advanced Practice Midwife | 
| Location | 1001 Hart Blvd Ste 100, Monticello, Minnesota | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1083228092 | NPI | - | NPPES | 
| 204419-0 | Other | MN | REGISTERED NURSING LICENSE | 
| CNM09522 | Other | MN | CERTIFIED NURSE MIDWIFE | 
| 591 | Other | MN | APRN LICENSE | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 163WX0002X | Registered Nurse - Obstetric, High-risk | 204419-0 (Minnesota) | Secondary | 
| 367A00000X | Advanced Practice Midwife | 591 (Minnesota) | Primary | 
| Entity Name | Stellis Health Pa | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1184664674 PECOS PAC ID: 1153233796 Enrollment ID: O20031103000458  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Kristin Deneille Hazeman, DNP, APRN, CNM 19170 Jasper St Nw, Anoka, MN 55303-9639 Ph: (612) 867-7331  | Kristin Deneille Hazeman, DNP, APRN, CNM 1001 Hart Blvd Ste 100, Monticello, MN 55362-8929 Ph: (763) 295-2921  | 
Diane B Larson, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 1001 Hart Blvd, Ste 100, Monticello, MN 55362 Phone: 763-295-2921  | |
Jessica Borgstrom, CNM Advanced Practice Midwife Medicare: Accepting Medicare Assignments Practice Location: 1001 Hart Blvd #100, Monticello, MN 55362 Phone: 763-295-2921  |