Healthcare Provider Details

I. General information

NPI: 1548025893
Provider Name (Legal Business Name): KATHERINE SAPP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE TATE

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 8TH ST
THOMPSON ND
58278-4145
US

IV. Provider business mailing address

412 8TH ST
THOMPSON ND
58278-4145
US

V. Phone/Fax

Practice location:
  • Phone: 701-213-8029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR51538
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: