Provider Demographics
NPI:1821011685
Name:TSCHIDA, KATHLEEN LORRAINE (RN CNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LORRAINE
Last Name:TSCHIDA
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1737 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2185
Mailing Address - Country:US
Mailing Address - Phone:651-770-3320
Mailing Address - Fax:651-770-3684
Practice Address - Street 1:1737 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2185
Practice Address - Country:US
Practice Address - Phone:651-770-3320
Practice Address - Fax:651-770-3684
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR057574-2363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13787Medicare UPIN