Healthcare Provider Details

I. General information

NPI: 1467400689
Provider Name (Legal Business Name): KAREN RAE PIETRAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTH 31ST STREET SUITE 201
GRAND FORKS ND
58201-3593
US

IV. Provider business mailing address

3535 SOUTH 31ST STREET SUITE 201
GRAND FORKS ND
58201-3593
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6821
  • Fax: 701-780-1973
Mailing address:
  • Phone: 701-780-6821
  • Fax: 701-780-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3016
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: