Healthcare Provider Details

I. General information

NPI: 1578592267
Provider Name (Legal Business Name): DIANNA MAE KACHINSKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 10TH AVE NE
DEER RIVER MN
56636-8703
US

IV. Provider business mailing address

1025 10TH AVE NE
DEER RIVER MN
56636-8703
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-8275
  • Fax: 218-246-8279
Mailing address:
  • Phone: 218-246-8275
  • Fax: 218-246-8279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0900388
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: