Healthcare Provider Details

I. General information

NPI: 1134474810
Provider Name (Legal Business Name): KATHERINE ALICE SENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S COLUMBIA RD
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax: 701-780-4477
Mailing address:
  • Phone: 701-780-1891
  • Fax: 701-780-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14947
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTRL 12409
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number119648
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number14947
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: