Provider Demographics
NPI:1902854649
Name:HARTHUN, KATHLEEN YVONNE (RNC, FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:YVONNE
Last Name:HARTHUN
Suffix:
Gender:F
Credentials:RNC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28132 380TH ST
Mailing Address - Street 2:
Mailing Address - City:DENT
Mailing Address - State:MN
Mailing Address - Zip Code:56528-9237
Mailing Address - Country:US
Mailing Address - Phone:218-758-2804
Mailing Address - Fax:
Practice Address - Street 1:401 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551-4026
Practice Address - Country:US
Practice Address - Phone:218-583-2953
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 080272-9363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS68990Medicare UPIN