Provider Demographics
NPI:1518019389
Name:RAJEK, KATHLEEN GAIL (LPN, CST, CFA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GAIL
Last Name:RAJEK
Suffix:
Gender:F
Credentials:LPN, CST, CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 FRANCE AVE S STE W400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2192
Mailing Address - Country:US
Mailing Address - Phone:952-920-2730
Mailing Address - Fax:763-383-2134
Practice Address - Street 1:6405 FRANCE AVE S STE W400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2192
Practice Address - Country:US
Practice Address - Phone:952-920-2730
Practice Address - Fax:763-383-2134
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0214605246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN89A15RAOtherBCBS