MEDICARE: KATHERINE AMBER FUGLIE B.S.

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1932237989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE AMBER FUGLIE B.S.

Provider Business Mailing Address
First Line	:	904 NE 3RD AVE
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2818
Country	:	US
Telephone Number	:	218-259-3597
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 NE 3RD AVE
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2818
Country	:	US
Telephone Number	:	218-259-3597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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