Provider Demographics
NPI:1881828358
Name:ESTRADA, KATHERINE MARIE (MSN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10081 DOGWOOD ST NW STE 100
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5282
Mailing Address - Country:US
Mailing Address - Phone:763-783-3722
Mailing Address - Fax:763-783-7944
Practice Address - Street 1:10081 DOGWOOD ST NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-5282
Practice Address - Country:US
Practice Address - Phone:763-783-3722
Practice Address - Fax:763-783-7944
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT101.0047176363LP0200X
MNR-217513-7363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics