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NPI Code Detail

MEDICARE: KATHERINE LILLIE LOFBERG FNP-C

MEDICARE: KATHERINE LILLIE LOFBERG FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerR1070084MN
2363L00000XNurse Practitioner56MN

General Provider Information

NPI Number : 1134105703
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE LILLIE LOFBERG FNP-C
Provider Business Mailing Address
First Line : 500 W GRANT ST
Second Line :
City : LAKE CITY
State : MN
Zip : 55041-1143
Country : US
Telephone Number : 651-345-3321
Fax Number : 651-345-1151
Provider Business Practice Location Address
First Line : 500 W GRANT ST
Second Line :
City : LAKE CITY
State : MN
Zip : 55041-1143
Country : US
Telephone Number : 651-345-3321
Fax Number : 651-345-1151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 09/28/2020

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Directions to “ KATHERINE LILLIE LOFBERG FNP-C” Practice Location

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