Healthcare Provider Details

I. General information

NPI: 1922859180
Provider Name (Legal Business Name): KATHLEEN MARIE FELDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 NW 4TH ST
GRAND RAPIDS MN
55744-2205
US

IV. Provider business mailing address

1107 NW 4TH ST
GRAND RAPIDS MN
55744-2205
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-0095
  • Fax: 218-999-0214
Mailing address:
  • Phone: 218-326-0095
  • Fax: 218-999-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2465123
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: