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General NPI Number Information
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NPI Number | 1013499367
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Entity Type | Individual
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Provider Name | KATHRYN ANN ALVAREZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4040 COON RAPIDS BLVD NW STE 120
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City | COON RAPIDS
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State | MN
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Zip | 55433-4568
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Country | US
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Telephone | 634-279-9807
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Fax | 763-427-0904
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 612-262-9000
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Fax | 763-581-9090
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12802
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License Number State | MN
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