Basic Information
Provider Information | |||||||||
NPI: | 1205825593 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAISER | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2168 | ||||||||
Address2: |   | ||||||||
City: | FARGO | ||||||||
State: | ND | ||||||||
PostalCode: | 581072168 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7012342119 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 420 SOUTH 7TH STREET | ||||||||
Address2: |   | ||||||||
City: | OAKES | ||||||||
State: | ND | ||||||||
PostalCode: | 584742024 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7017423267 | ||||||||
FaxNumber: | 7017423201 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/19/2005 | ||||||||
LastUpdateDate: | 01/22/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R14200 | ND | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 28598 | 01 | ND | BLUE SHIELD | OTHER | 500007865 | 01 | ND | RAILROAD MEDICARE | OTHER | 19185 | 01 | ND | BLUE SHIELD | OTHER | CF8850 | 01 | ND | RAILROAD MEDICARE | OTHER | 18174 | 01 | ND | BLUE SHIELD | OTHER | 28597 | 01 | ND | BLUE SHIELD | OTHER | 28599 | 01 | ND | BLUE SHIELD | OTHER | 18176 | 01 | ND | BLUE SHIELD | OTHER | 25959 | 01 | ND | BLUE SHIELD | OTHER |