Provider Demographics
NPI:1396971461
Name:HALDER, KATIE MARIE (RN, CNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:HALDER
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4868
Mailing Address - Country:US
Mailing Address - Phone:507-454-3650
Mailing Address - Fax:
Practice Address - Street 1:109 W JESSIE ST
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-8837
Practice Address - Country:US
Practice Address - Phone:507-864-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 156915-5163WC1500X
MNR156915-5363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health