Healthcare Provider Details

I. General information

NPI: 1609024652
Provider Name (Legal Business Name): KATHERINE THERESE GANSEN ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W MAIN ST
MANCHESTER IA
52057-1526
US

IV. Provider business mailing address

709 W MAIN ST
MANCHESTER IA
52057-1526
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-7777
  • Fax: 563-583-3760
Mailing address:
  • Phone: 563-927-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-112756
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: