Provider Demographics
NPI:1619956653
Name:DAVIS, CATHERINE A
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:DAVIS
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 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1400 E MADISON AVE STE 400A
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6805
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7K350DAOtherBCBS
MN1202256OtherMEDICA
MNNA2951023823OtherPREFERRED ONE
MN144719000Medicaid
370005354OtherRR MEDICARE
IA0965525OtherMEDICAID
MN121155OtherUCARE
MNHP25201OtherHEALTH PARTNERS
410849339 56001 C101OtherCHAMPUS
MN658425OtherAMERICAS PPO
410849339 56001 C101OtherCHAMPUS
370005354OtherRR MEDICARE