Provider Demographics
NPI:1235419326
Name:BELOUSOVA, KATERINA O (PA-C)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:O
Last Name:BELOUSOVA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:21395 JOHN MILLESS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4402
Mailing Address - Country:US
Mailing Address - Phone:763-504-6400
Mailing Address - Fax:763-504-6410
Practice Address - Street 1:10000 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1400
Practice Address - Country:US
Practice Address - Phone:763-572-5700
Practice Address - Fax:763-596-6200
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2020-08-24
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Provider Licenses
StateLicense IDTaxonomies
MN10920363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant