=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487619904
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. CATHLEEN MARY DOLORES JANITSCHKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 EASTVOLD AVE
-----------------------------------------------------
City | ORTONVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56278-1133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-839-2502
-----------------------------------------------------
Fax | 320-839-3851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 EASTVOLD AVE
-----------------------------------------------------
City | ORTONVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56278-1133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-839-2502
-----------------------------------------------------
Fax | 320-839-3851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | R110815-0
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------