Basic Information
| Provider Information | |||||||||
| NPI: | 1053571109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANN | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE S # MS 21110Q | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635874800 | ||||||||
| FaxNumber: | 7635874885 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 3RD ST NW | ||||||||
| Address2: | RIVERWAY CLINIC-ELK RIVER-MAIL STOP 39400A | ||||||||
| City: | ELK RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553308863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635874800 | ||||||||
| FaxNumber: | 7635874885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2008 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-8309 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53747 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.