Provider Demographics
NPI:1659634855
Name:MENNE, KATHRYN SHEEHAN
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SHEEHAN
Last Name:MENNE
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 1:4692 FABLE HILL PKWY N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-3304
Mailing Address - Country:US
Mailing Address - Phone:651-605-1182
Mailing Address - Fax:
Practice Address - Street 1:4692 FABLE HILL PKWY N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-3304
Practice Address - Country:US
Practice Address - Phone:651-605-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 174611-4367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered