Healthcare Provider Details

I. General information

NPI: 1902854649
Provider Name (Legal Business Name): KATHLEEN YVONNE HARTHUN RNC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DOUGLAS AVE
HENNING MN
56551-4026
US

IV. Provider business mailing address

28132 380TH ST
DENT MN
56528-9237
US

V. Phone/Fax

Practice location:
  • Phone: 218-583-2953
  • Fax:
Mailing address:
  • Phone: 218-758-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 080272-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: