Provider Demographics
NPI:1598776999
Name:BEUNING, KATHLEEN ALICE (CNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALICE
Last Name:BEUNING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37905 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MN
Mailing Address - Zip Code:56310-8704
Mailing Address - Country:US
Mailing Address - Phone:320-746-2974
Mailing Address - Fax:
Practice Address - Street 1:37905 186TH AVENUE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MN
Practice Address - Zip Code:56310-8704
Practice Address - Country:US
Practice Address - Phone:320-746-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR088709-0363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health