Healthcare Provider Details

I. General information

NPI: 1598921108
Provider Name (Legal Business Name): KATHARINE JONES PLOSSER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2008
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 42ND AVE S
MINNEAPOLIS MN
55406-3503
US

IV. Provider business mailing address

3809 42ND AVE S
MINNEAPOLIS MN
55406-3503
US

V. Phone/Fax

Practice location:
  • Phone: 612-721-6261
  • Fax:
Mailing address:
  • Phone: 612-721-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004067
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012648
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11353
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: