Provider Demographics
NPI:1376143610
Name:KAPP, MARY ANN
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:ND
Mailing Address - Zip Code:58428-0224
Mailing Address - Country:US
Mailing Address - Phone:701-327-2164
Mailing Address - Fax:
Practice Address - Street 1:238 COOK ST SW
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:ND
Practice Address - Zip Code:58428
Practice Address - Country:US
Practice Address - Phone:701-327-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant