Provider Demographics
NPI:1568456168
Name:PROEBSTLE, CATHERINE BEMIS (MSN RNCFNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BEMIS
Last Name:PROEBSTLE
Suffix:
Gender:F
Credentials:MSN RNCFNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:BEMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN RNCFNP
Mailing Address - Street 1:14000 NICOLLET AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5793
Mailing Address - Country:US
Mailing Address - Phone:651-688-9000
Mailing Address - Fax:888-425-4826
Practice Address - Street 1:14000 NICOLLET AVE STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:612-467-9724
Practice Address - Fax:888-425-4826
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1179587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN333642500Medicaid