Provider Demographics
NPI:1639698194
Name:DAUBLE, KATHRYN LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:DAUBLE
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3930 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-6963
Practice Address - Country:US
Practice Address - Phone:952-853-8800
Practice Address - Fax:651-523-8584
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2021-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN5352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner