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General NPI Number Information
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NPI Number | 1417033507
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Entity Type | Individual
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Provider Name | KAREN J LESETMOE PA
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 323 S MINNESOTA ST
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City | CROOKSTON
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State | MN
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Zip | 56716-1601
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Country | US
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Telephone | 800-746-6551
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Fax |
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Provider Business Mailing Address
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Address Line | 16149 N TRINITY POINT RD SE
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City | MENTOR
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State | MN
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Zip | 56736-9493
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Country | US
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Telephone | 218-687-4144
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9483
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License Number State | MN
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