Healthcare Provider Details

I. General information

NPI: 1720636814
Provider Name (Legal Business Name): KHAMKEO SAESEE APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2019
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ELTON HILLS DR NW STE 200
ROCHESTER MN
55901-3564
US

IV. Provider business mailing address

210 9TH ST SE
ROCHESTER MN
55904-6756
US

V. Phone/Fax

Practice location:
  • Phone: 507-280-1824
  • Fax:
Mailing address:
  • Phone: 507-288-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6886
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: