Provider Demographics
NPI:1063481364
Name:HOVERSTEN, KATHRYN B (CNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:B
Last Name:HOVERSTEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:HOVERSTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:3366 OAKDALE AVE N STE 450
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2957
Mailing Address - Country:US
Mailing Address - Phone:763-257-4400
Mailing Address - Fax:763-520-1791
Practice Address - Street 1:3366 OAKDALE AVE N STE 450
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2957
Practice Address - Country:US
Practice Address - Phone:763-257-4400
Practice Address - Fax:763-520-1791
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1032158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P17864Medicare UPIN