Healthcare Provider Details

I. General information

NPI: 1922244227
Provider Name (Legal Business Name): KARI SUE ROBERTSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARI SUE BEASLEY RN

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S LAKE AVE SUITE 218
DULUTH MN
55802-2362
US

IV. Provider business mailing address

525 S LAKE AVE SUITE 218
DULUTH MN
55802-2362
US

V. Phone/Fax

Practice location:
  • Phone: 218-740-1172
  • Fax:
Mailing address:
  • Phone: 218-740-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 156728-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: