Healthcare Provider Details

I. General information

NPI: 1396971461
Provider Name (Legal Business Name): KATIE MARIE HALDER RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W JESSIE ST
RUSHFORD MN
55971-8837
US

IV. Provider business mailing address

855 MANKATO AVE
WINONA MN
55987-4868
US

V. Phone/Fax

Practice location:
  • Phone: 507-864-7726
  • Fax:
Mailing address:
  • Phone: 507-454-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR 156915-5
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR156915-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: