Provider Demographics
NPI:1952608648
Name:TREPTAU, MARY KATHRYN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:TREPTAU
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7087 20TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-9006
Mailing Address - Country:US
Mailing Address - Phone:763-412-0234
Mailing Address - Fax:
Practice Address - Street 1:7087 20TH ST NE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-9006
Practice Address - Country:US
Practice Address - Phone:763-412-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 51643-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse