Individual
KATY L CHARBONEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R 156566-7
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133428000
—
MN
01
—
P00733624
MEDICARE RAILROAD
MN
Enumeration date
10/19/2006
Last updated
09/11/2009
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