Petersburg, Kathy L

Petersburg, Kathy L is an individual health care provider with primary practice located at 901 Montgomery St , Decorah IA 52101-2325. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Petersburg, Kathy L can be contacted via phone (563) 382-2911.

Contact Information

Primary practice address
901 Montgomery St Decorah IA 52101-2325
Phone: (563) 382-2911
Fax: (563) 387-3102
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 0696743-1 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X J073230 Iowa

Profile Details

NPI number 1508860974
LBN Legal business name Petersburg, Kathy L
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2005
Last updated Jan 22nd, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508860974 NPPES
Minnesota MEDICAID 838721400
Minnesota MEDICAID 1432070

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