Healthcare Provider Details

I. General information

NPI: 1144733551
Provider Name (Legal Business Name): MARIA KATHLEEN HORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA KATHLEEN SEVENICH

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 HELMO AVE N STE 100
OAKDALE MN
55128-6034
US

IV. Provider business mailing address

1690 UNIVERSITY AVE W STE 370
SAINT PAUL MN
55104-3723
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-5300
  • Fax:
Mailing address:
  • Phone: 651-232-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09171217
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: