Healthcare Provider Details

I. General information

NPI: 1346374048
Provider Name (Legal Business Name): KARI A O COMNICK CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SIXTH AVE NO CENTRA CARE CLINIC
ST CLOUD MN
56303
US

IV. Provider business mailing address

1200 SIXTH AVE NO CENTRA CARE CLINIC
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5131
  • Fax:
Mailing address:
  • Phone: 320-252-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR1403321
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: