Basic Information
| Provider Information | |||||||||
| NPI: | 1144745308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLOCK | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5349 LOGAN AVE S | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554191048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127998262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 270 MAIN ST N STE 300 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550826788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513421039 | ||||||||
| FaxNumber: | 6513421428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2017 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 12483 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | 12483 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.