Healthcare Provider Details

I. General information

NPI: 1417895012
Provider Name (Legal Business Name): KATHRINE KARE JOHANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N TOWER RD
FERGUS FALLS MN
56537-1016
US

IV. Provider business mailing address

930 N 1ST AVE
FERGUS FALLS MN
56537-1125
US

V. Phone/Fax

Practice location:
  • Phone: 218-739-2217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT201
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH9643
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: