Healthcare Provider Details

I. General information

NPI: 1255144739
Provider Name (Legal Business Name): KATHLEEN MARIE BROVIAK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2099
US

IV. Provider business mailing address

4801 VETERANS DR
SAINT CLOUD MN
56303-2099
US

V. Phone/Fax

Practice location:
  • Phone: 320-656-1670
  • Fax:
Mailing address:
  • Phone: 320-656-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number818168
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: