Healthcare Provider Details

I. General information

NPI: 1619956919
Provider Name (Legal Business Name): CATHY SCHMIDT KLICK RN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W FOUNTAIN ST
ALBERT LEA MN
56007-2437
US

IV. Provider business mailing address

817 LAKEVIEW BLVD
ALBERT LEA MN
56007-4430
US

V. Phone/Fax

Practice location:
  • Phone: 507-373-2384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 101803-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: