1720255367 NPI number — KATHERINE GRACE ESSE MD

Table of content: KATHERINE GRACE ESSE MD (NPI 1720255367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720255367 NPI number — KATHERINE GRACE ESSE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESSE
Provider First Name:
KATHERINE
Provider Middle Name:
GRACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720255367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 CHICAGO AVE
Provider Second Line Business Mailing Address:
MAIL ROUTE 10202
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-262-1166
Provider Business Mailing Address Fax Number:
612-262-4258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 SMITH AVE N
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-241-6550
Provider Business Practice Location Address Fax Number:
651-241-6586
Provider Enumeration Date:
05/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  58332 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 58332 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)