Healthcare Provider Details

I. General information

NPI: 1932237989
Provider Name (Legal Business Name): KATHERINE AMBER FUGLIE B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 NE 3RD AVE
GRAND RAPIDS MN
55744-2818
US

IV. Provider business mailing address

904 NE 3RD AVE
GRAND RAPIDS MN
55744-2818
US

V. Phone/Fax

Practice location:
  • Phone: 218-259-3597
  • Fax:
Mailing address:
  • Phone: 218-259-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: