MEDICARE: KATHERINE MILLICENT NASH PA-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
1	363A00000X	Physician Assistant	14831	MN

General Provider Information

NPI Number	:	1699533869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MILLICENT NASH PA-C

Provider Business Mailing Address
First Line	:	2525 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4518
Country	:	US
Telephone Number	:	612-813-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 CHICAGO AVE STE 32-2516
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4518
Country	:	US
Telephone Number	:	612-813-6295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	06/13/2024

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