Basic Information
| Provider Information | |||||||||
| NPI: | 1518946516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NETSCH | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | RN NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 E MAIN ST PO BOX 8674 | ||||||||
| Address2: | MANKATO CLINIC LTD | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | MANKATO CLINIC AT MAIN STREET | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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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 | 363L00000X | R1284252 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 02Q97NE | 01 | MN | BCBS | OTHER | HP42077 | 01 | MN | HEALTH PARTNERS | OTHER | 124684 | 01 | MN | UCARE | OTHER | 410849339 56001 C112 | 01 | CHAMPUS | OTHER | 0120539 | 01 | MN | MEDICA | OTHER | 2380346 | 01 | MN | AMERICAS PPO | OTHER | 500009849 | 01 | RR MEDICARE | OTHER | NA2951023876 | 01 | MN | PREFERRED ONE | OTHER | 0104221 | 01 | MN | MEDICA | OTHER | 459816400 | 05 | MN | MEDICAID | 938357 | 05 | IA | MEDICAID |