Basic Information
| Provider Information | |||||||||
| NPI: | 1144733551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORNE | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SEVENICH | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | KATHLEEN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1690 UNIVERSITY AVE W STE 370 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512325321 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1099 HELMO AVE N STE 100 | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551286034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513265300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F09171217 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.