Healthcare Provider Details

I. General information

NPI: 1568456168
Provider Name (Legal Business Name): CATHERINE BEMIS PROEBSTLE MSN RNCFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE BEMIS MSN RNCFNP

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 NICOLLET AVE STE 100
BURNSVILLE MN
55337
US

IV. Provider business mailing address

14000 NICOLLET AVE STE 100
BURNSVILLE MN
55337-5793
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-9724
  • Fax: 888-425-4826
Mailing address:
  • Phone: 651-688-9000
  • Fax: 888-425-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1179587
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: