Individual
KATARA JO HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2595
(651) 254-3456
Mailing address
4128 ELLIOT AVE, MINNEAPOLIS, MN 55407-3149
(320) 333-8047
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2566
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/05/2020
Last updated
02/05/2021
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