Healthcare Provider Details

I. General information

NPI: 1104865682
Provider Name (Legal Business Name): KATHLEEN MARY CONNORS CNRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST 305 PIPER BLDG.
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

800 E 28TH ST 305 PIPER BLDG.
MINNEAPOLIS MN
55407-3723
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-7278
  • Fax: 612-879-7189
Mailing address:
  • Phone: 612-871-7278
  • Fax: 612-879-7189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR0763253
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: