Healthcare Provider Details

I. General information

NPI: 1689408783
Provider Name (Legal Business Name): KATHLYN FRIEDRICH RN NC-BC MBA MHA MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12777 KINGSVIEW LN N
DAYTON MN
55327-9442
US

IV. Provider business mailing address

12777 KINGSVIEW LN N
DAYTON MN
55327-9442
US

V. Phone/Fax

Practice location:
  • Phone: 612-750-8417
  • Fax:
Mailing address:
  • Phone: 612-750-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberR-148591-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: