Basic Information
| Provider Information | |||||||||
| NPI: | 1316226970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODVOLD | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 CHICAGO AVE S | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512257800 | ||||||||
| FaxNumber: | 6512257820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 WESTGATE DR | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551141065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121505 | ||||||||
| FaxNumber: | 6516411720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2011 | ||||||||
| LastUpdateDate: | 08/12/2011 | ||||||||
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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 | 163W00000X | R1280586 | MN | Y | Nursing Service Providers | Registered Nurse |
No ID Information.