Healthcare Provider Details

I. General information

NPI: 1861464042
Provider Name (Legal Business Name): CATHY RESNICK SACKETT WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 LEE AVE N MAIL STOP 31400A
BROOKLYN CENTER MN
55429-1717
US

IV. Provider business mailing address

8100 34TH AVE S 21110Q
BLOOMINGTON MN
55425-1672
US

V. Phone/Fax

Practice location:
  • Phone: 763-569-0300
  • Fax: 763-569-0311
Mailing address:
  • Phone: 952-883-7961
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0993997
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: