Healthcare Provider Details

I. General information

NPI: 1801893227
Provider Name (Legal Business Name): BERTHA M KLASSEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 10TH ST
WINDOM MN
56101-1451
US

IV. Provider business mailing address

308 10TH ST
WINDOM MN
56101-1451
US

V. Phone/Fax

Practice location:
  • Phone: 507-831-2223
  • Fax: 507-831-0135
Mailing address:
  • Phone: 507-831-2223
  • Fax: 507-831-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR043454-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: