Healthcare Provider Details

I. General information

NPI: 1063481364
Provider Name (Legal Business Name): KATHRYN B HOVERSTEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY HOVERSTEN CNP

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 OAKDALE AVE N STE 450
ROBBINSDALE MN
55422-2957
US

IV. Provider business mailing address

3366 OAKDALE AVE N STE 450
ROBBINSDALE MN
55422-2957
US

V. Phone/Fax

Practice location:
  • Phone: 763-257-4400
  • Fax: 763-520-1791
Mailing address:
  • Phone: 763-257-4400
  • Fax: 763-520-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1032158
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: