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NPI Code Detail

MEDICARE: KATHERINE ANN NATHAN P.A.

MEDICARE: KATHERINE ANN NATHAN P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1876WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780742197
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE ANN NATHAN P.A.
Provider Business Mailing Address
First Line : 204 LUNDORFF DR
Second Line :
City : SANDSTONE
State : MN
Zip : 55072-5051
Country : US
Telephone Number : 320-245-2250
Fax Number : 320-245-2555
Provider Business Practice Location Address
First Line : 204 LUNDORFF DR
Second Line :
City : SANDSTONE
State : MN
Zip : 55072-5051
Country : US
Telephone Number : 320-245-2250
Fax Number : 320-245-2555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 01/03/2013

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