Basic Information
Provider Information
NPI: 1174698807
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CURNOW
FirstName: LOUISE
MiddleName: AMY HILDE
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4325 GRAND AVE
Address2:  
City: DULUTH
State: MN
PostalCode: 558072730
CountryCode: US
TelephoneNumber: 2187221497
FaxNumber: 2187278346
Practice Location
Address1: 4325 GRAND AVE
Address2:  
City: DULUTH
State: MN
PostalCode: 558072730
CountryCode: US
TelephoneNumber: 2187221497
FaxNumber: 2187278346
Other Information
ProviderEnumerationDate: 11/21/2006
LastUpdateDate: 11/01/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X9967MNY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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